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General NPI Number Information
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NPI Number | 1790679512
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Entity Type | Organization
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Legal Business Name | CRESCENT CITY SURGICAL CENTRE DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 2805 W MALL DR
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City | FLORENCE
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State | AL
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Zip | 35630-1563
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Country | US
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Telephone | 504-766-9882
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Fax | 504-504-5211
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Provider Business Mailing Address
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Address Line | 2805 W MALL DR
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City | FLORENCE
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State | AL
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Zip | 35630-1563
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Country | US
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Telephone | 504-766-9882
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | WILLIAM LAWRENCE BOUCHILLON
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Credential |
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Telephone | 504-766-9882
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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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