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General NPI Number Information
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NPI Number | 1174577860
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Entity Type | Organization
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Legal Business Name | ACCUMED OF SOUTH LOUISIANA, L.L.C.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 7385 ALBERTA DR
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City | BATON ROUGE
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State | LA
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Zip | 70808-4102
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Country | US
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Telephone | 225-706-1101
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Fax | 225-663-6778
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Provider Business Mailing Address
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Address Line | 7385 ALBERTA DR
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City | BATON ROUGE
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State | LA
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Zip | 70808-4102
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Country | US
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Telephone | 225-706-1101
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Fax | 225-663-6778
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL J MORAN
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Credential | MS
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Telephone | 225-706-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | 1000686651
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License Number State | LA
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