Provider Demographics
NPI:1023384393
Name:VASCULAR SPECIALTY CENTER LAB
Entity Type:Organization
Organization Name:VASCULAR SPECIALTY CENTER LAB
Other - Org Name:VASCULAR SPECIALTY CENTER LAB MOBILE UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:225-769-4493
Mailing Address - Street 1:8888 SUMMA AVE
Mailing Address - Street 2:CARDIOLOGY TOWER 3RD FL STE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3720
Mailing Address - Country:US
Mailing Address - Phone:225-231-5103
Mailing Address - Fax:225-925-9378
Practice Address - Street 1:8888 SUMMA AVE
Practice Address - Street 2:CARDIOLOGY TOWER 3RD FL STE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3720
Practice Address - Country:US
Practice Address - Phone:225-769-4266
Practice Address - Fax:225-819-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory