=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952512733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST BANK ULTRASOUND LABSERVICES,L.L.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24730 PLAZA DRIVE
-----------------------------------------------------
City | PLAQUEMINE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-253-9542
-----------------------------------------------------
Fax | 225-687-8395
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24730 PLAZA DRIVE
-----------------------------------------------------
City | PLAQUEMINE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-253-9542
-----------------------------------------------------
Fax | 225-687-8395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAWN T LUKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-253-9542
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 36420648K
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------