Healthcare Provider Details

I. General information

NPI: 1437497674
Provider Name (Legal Business Name): B.A.T. COLLECTION SERVICE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 LIBERTY ST
MONROE LA
71201-3623
US

IV. Provider business mailing address

2207 LIBERTY ST
MONROE LA
71201-3623
US

V. Phone/Fax

Practice location:
  • Phone: 318-509-8165
  • Fax:
Mailing address:
  • Phone: 318-509-8165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberQ5P2L5Z7
License Number StateLA

VIII. Authorized Official

Name: TENITA R JACKSON
Title or Position: PHLEBOTOMIST/OWNER
Credential:
Phone: 318-884-3311