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General NPI Number Information
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NPI Number | 1588955009
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Entity Type | Organization
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Legal Business Name | VASCULAR TESTING OF ACADIANA
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 386 ROXSAN RD
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City | SUNSET
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State | LA
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Zip | 70584-5165
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Country | US
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Telephone | 337-945-4953
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Fax | 866-390-5469
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Provider Business Mailing Address
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Address Line | 386 ROXSAN RD
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City | SUNSET
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State | LA
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Zip | 70584-5165
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Country | US
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Telephone | 337-945-4953
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Fax | 866-390-5469
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEVIN J. TATE
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Credential | RVT,RCS
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Telephone | 337-945-4953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 158325
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License Number State | LA
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