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General NPI Number Information
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NPI Number | 1437690849
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Entity Type | Organization
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Legal Business Name | BIOSTAT LABORATORIES, LLC
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Dates
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Enumeration Date | 03/17/2017
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 9742 SAINT VINCENT AVE STE 200
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City | SHREVEPORT
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State | LA
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Zip | 71106
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Country | US
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Telephone | 318-606-6050
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Fax | 318-606-6051
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Provider Business Mailing Address
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Address Line | 1651 E 70TH ST PMB 404
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City | SHREVEPORT
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State | LA
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Zip | 71105-5115
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Country | US
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Telephone | 318-798-3306
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Fax | 318-798-3386
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Authorized Official
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Title or Position | CEO
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Name | RON J. KILGARLIN JR.
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Credential |
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Telephone | 318-798-3306
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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 | 42273804K
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License Number State | LA
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