MEDICARE: KW LAB & INSURANCE SERVICES, 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

General Provider Information

NPI Number	:	1851998520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KW LAB & INSURANCE SERVICES, LLC

Provider Business Mailing Address
First Line	:	3695 RIDGEMONT DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70814-4629
Country	:	US
Telephone Number	:	225-819-3335
Fax Number	:	800-212-2609

Provider Business Practice Location Address
First Line	:	11843 BRICKSOME AVE STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5310
Country	:	US
Telephone Number	:	225-819-3335
Fax Number	:	800-212-2609

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MS. KASSANDRA WILLIAMS
Credential	:	RN
Telephone Number	:	225-892-9494

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	12/04/2020

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