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General NPI Number Information
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NPI Number | 1548577703
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Entity Type | Organization
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Legal Business Name | PRIORITY LABORATORY SERVICES
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 4700 WICHERS DR SUITE 303
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City | MARRERO
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State | LA
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Zip | 70072-3041
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Country | US
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Telephone | 504-218-0717
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Fax | 504-218-2301
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Provider Business Mailing Address
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Address Line | 4700 WICHERS DR SUITE 303
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City | MARRERO
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State | LA
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Zip | 70072-3041
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Country | US
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Telephone | 504-218-0717
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Fax | 504-218-2301
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | MR. ISREAL BENNETT JR.
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Credential | MT(ASCP) NCA (CLS)
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Telephone | 504-231-4176
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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 | 19D2009795
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License Number State | LA
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