Healthcare Provider Details

I. General information

NPI: 1740463207
Provider Name (Legal Business Name): EUNICE MEDICAL LABORATORY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MOOSA BLVD SUITE C
EUNICE LA
70535-3610
US

IV. Provider business mailing address

450 MOOSA BLVD SUITE C
EUNICE LA
70535-3610
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 Number19D1075897
License Number StateLA

VIII. Authorized Official

Name: MR. DAVID DARBONNE
Title or Position: PRESIDENT
Credential: M.T.
Phone: 337-457-5562