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General NPI Number Information
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NPI Number | 1992688535
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Entity Type | Organization
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Legal Business Name | IMPETUS DIAGNOSTICS LLC
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 4752 HIGHWAY 311 STE 112
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City | HOUMA
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State | LA
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Zip | 70360-2810
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Country | US
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Telephone | 855-482-3598
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Fax |
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Provider Business Mailing Address
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Address Line | 4752 HIGHWAY 311 STE 112
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City | HOUMA
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State | LA
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Zip | 70360-2810
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Country | US
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Telephone | 855-482-3598
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Fax |
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Authorized Official
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Title or Position | OWNER, MANAGER
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Name | ANDREW YEATES
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Credential |
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Telephone | 985-580-9703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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