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General NPI Number Information
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NPI Number | 1730548504
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Entity Type | Organization
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Legal Business Name | TLM DIAGNOSTICS LLC
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 9441 STEVENS RD SUITE 100
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City | SHREVEPORT
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State | LA
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Zip | 71106-7567
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Country | US
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Telephone | 318-861-0252
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Fax |
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Provider Business Mailing Address
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Address Line | 9441 STEVENS RD SUITE 100
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City | SHREVEPORT
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State | LA
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Zip | 71106-7567
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Country | US
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Telephone | 318-861-0252
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONNA POIMBOEUF
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Credential | BSMT(ASCP)
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Telephone | 318-861-0252
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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 | 19D0463281
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License Number State | LA
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