Healthcare Provider Details

I. General information

NPI: 1932218609
Provider Name (Legal Business Name): PHYSICIANS ANALYTICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 HEAVENS DRIVE SUITE 201
MANDEVILLE LA
70471
US

IV. Provider business mailing address

PO BOX 8568
MANDEVILLE LA
70470-8568
US

V. Phone/Fax

Practice location:
  • Phone: 985-845-8810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD019070
License Number StateLA

VIII. Authorized Official

Name: MR. PAUL GREMILLION
Title or Position: PRESIDENT
Credential:
Phone: 985-845-4595