MEDICARE: EVANGELINE DIAGNOSTIC CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	19D0461630	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19D0461630	OTHER	LA	CLIA
2	36930	OTHER	LA	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518950732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANGELINE DIAGNOSTIC CENTER LLC

Provider Business Mailing Address
First Line	:	11842 JUSTICE AVENUE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816
Country	:	US
Telephone Number	:	225-448-5886
Fax Number	:	225-292-5956

Provider Business Practice Location Address
First Line	:	504 JACK MILLER ROAD, SUITE 1
Second Line	:
City	:	VILLE PLATTE
State	:	LA
Zip	:	70586
Country	:	US
Telephone Number	:	337-363-1465
Fax Number	:	337-363-1418

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. TERRY S WILKS JR.
Credential	:
Telephone Number	:	225-448-5886

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/21/2019

Similar Medicare Providers

1316098544 — DR. EDUARDO L ALVAREZ M.D.
Practice Location Address:

504 JACK MILLER RD , STE 9
VILLE PLATTE, LA
70586-5600

Practice Phone: 337-363-7228
Practice Fax: 337-363-6903

1164426003 — QUALITY MEDICAL CARE AND SERVICES, L.L.C.
Practice Location Address:

903 TATE COVE RD
VILLE PLATTE, LA
70586-3600

Practice Phone: 337-363-8101
Practice Fax: 337-363-8656

1972598712 — MR. DODANIM FRANCISCO ALTAMIRANO MD
Practice Location Address:

504 JACK MILLER RD , SUITE 3
VILLE PLATTE, LA
70586-5600

Practice Phone: 337-363-3560
Practice Fax: 337-363-3507

1578559407 — DR. JEFFERY JAKE LAFLEUR M.D.
Practice Location Address:

503 JACK MILLER RD , SUITE B
VILLE PLATTE, LA
70586-5607

Practice Phone: 337-363-1150
Practice Fax: 337-363-6203

1902892797 — CENTRAL LOUISIANA HOME HEALTH CARE LLC
Practice Location Address:

804 E MAIN ST
VILLE PLATTE, LA
70586-4618

Practice Phone: 337-252-6400
Practice Fax: 337-252-6402

1124019732 — THOMAS Y SOILEAU MD
Practice Location Address:

504 JACK MILLER RD , SUITE 2
VILLE PLATTE, LA
70586-5600

Practice Phone: 337-363-6480
Practice Fax: 337-363-6492

Directions to “EVANGELINE DIAGNOSTIC CENTER LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.