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General NPI Number Information
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NPI Number | 1780392589
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Entity Type | Organization
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Legal Business Name | ASC DIAGNOSTICS LLC
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 9742 SAINT VINCENT AVE STE 100
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City | SHREVEPORT
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State | LA
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Zip | 71106-7129
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Country | US
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Telephone | 318-798-3306
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Fax |
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Provider Business Mailing Address
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Address Line | 9742 SAINT VINCENT AVE STE 100
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City | SHREVEPORT
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State | LA
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Zip | 71106-7129
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Country | US
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Telephone | 318-798-3306
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | RON KILGARLIN
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Credential |
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Telephone | 318-606-6020
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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 |
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License Number State |
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