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General NPI Number Information
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NPI Number | 1386601581
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Entity Type | Organization
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Legal Business Name | SOUTHWEST LABORATORY SERVICES INC
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 2621 NORTH DRIVE SUITE A
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City | ABBEVILLE
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State | LA
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Zip | 70510
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Country | US
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Telephone | 337-898-8454
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Fax | 337-898-8402
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Provider Business Mailing Address
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Address Line | 2621 NORTH DRIVE SUITE A
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City | ABBEVILLE
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State | LA
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Zip | 70510
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Country | US
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Telephone | 337-898-8454
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Fax | 337-898-8402
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Authorized Official
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Title or Position | LAB MANAGER
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Name | MR. ANTOINETTE D MOSS
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Credential | MT ASCP
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Telephone | 337-898-8454
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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 | CLIA19D0461069
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License Number State | LA
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