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General NPI Number Information
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NPI Number | 1326133364
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Entity Type | Organization
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Legal Business Name | THE LABORATORY OF LEESVILLE, APMC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 1020 W FERTITTA BLVD
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City | LEESVILLE
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State | LA
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Zip | 71446-4649
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Country | US
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Telephone | 337-239-5496
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Fax | 337-239-5387
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Provider Business Mailing Address
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Address Line | PO BOX 679
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City | LEESVILLE
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State | LA
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Zip | 71496-0679
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Country | US
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Telephone | 337-239-5496
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Fax | 337-239-5387
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MUHAMMAD ANWAR MOLANI
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Credential | M.D.
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Telephone | 337-239-5496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 12708R
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License Number State | LA
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