=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396544136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICAL DIAGNOSTIC LABORATORY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2025
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3424 MEDICAL PARK DR STE 5-6
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71203-2387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-216-0711
-----------------------------------------------------
Fax | 318-216-1319
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3424 MEDICAL PARK DR STE 5-6
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71203-2387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-216-0711
-----------------------------------------------------
Fax | 318-216-1319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAMAL A SAADAT
-----------------------------------------------------
Credential | MLT
-----------------------------------------------------
Telephone | 318-216-0711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------