Healthcare Provider Details

I. General information

NPI: 1033116645
Provider Name (Legal Business Name): EUNICE MEDICAL CENTER LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MARTIN LUTHER KING DR SUITE B
EUNICE LA
70535-3644
US

IV. Provider business mailing address

301 N MARTIN LUTHER KING DR SUITE B
EUNICE LA
70535-3644
US

V. Phone/Fax

Practice location:
  • Phone: 337-457-5562
  • Fax: 337-550-7141
Mailing address:
  • Phone: 337-457-5562
  • Fax: 337-550-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number291U00000X
License Number StateLA

VIII. Authorized Official

Name: MR. LAWRENCE BOB COURVILLE
Title or Position: SUPERVISOR/OWNER
Credential: LMT
Phone: 337-457-5562