Healthcare Provider Details

I. General information

NPI: 1417099227
Provider Name (Legal Business Name): PERFORMANCE MEDICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 HICKORY AVE SUITE B
HARAHAN LA
70123-3104
US

IV. Provider business mailing address

551 HICKORY AVE SUITE B
HARAHAN LA
70123-3104
US

V. Phone/Fax

Practice location:
  • Phone: 504-734-1927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK W LOBELL
Title or Position: PRESIDENT
Credential:
Phone: 504-734-1927