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General NPI Number Information
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NPI Number | 1346582400
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Entity Type | Organization
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Legal Business Name | BURRELL MOBILE LAB
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 2101 TOWER DR
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City | MONROE
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State | LA
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Zip | 71201-5045
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Country | US
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Telephone | 504-210-6317
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Fax |
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Provider Business Mailing Address
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Address Line | 800 S 6TH ST
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City | MONROE
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State | LA
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Zip | 71202-2228
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY BURRELL
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Credential |
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Telephone | 504-210-6317
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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 | 19D2055006
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License Number State | LA
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