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General NPI Number Information
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NPI Number | 1447604749
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Entity Type | Organization
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Legal Business Name | PROTOCOL LABS, INC
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 8394 RUSHING RD E
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-7816
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Country | US
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Telephone | 985-951-2400
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Fax | 985-951-2404
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Provider Business Mailing Address
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Address Line | PO BOX 1227
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City | MANDEVILLE
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State | LA
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Zip | 70470-1227
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Country | US
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Telephone | 985-951-2400
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Fax | 985-951-2404
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Authorized Official
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Title or Position | OWNER
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Name | ROLAND MAYEUX
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Credential |
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Telephone | 985-951-2400
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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 | 90114589
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License Number State | LA
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