=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043968068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARK DIVERSIFIED HEALTHCARE SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2022
-----------------------------------------------------
Last Update Date | 12/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 N MORRISON BLVD STE 2
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70401-2233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-200-1092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 N MORRISON BLVD UNIT 2
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70401-2233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-200-1092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ANNE ELISE KOGER
-----------------------------------------------------
Credential | LAB DIRECTOR
-----------------------------------------------------
Telephone | 985-200-1092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------