Provider Demographics
NPI:1144386301
Name:STAT LABS I, INC
Entity Type:Organization
Organization Name:STAT LABS I, INC
Other - Org Name:ABP DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHOTELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-757-1084
Mailing Address - Street 1:7049 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4320
Mailing Address - Country:US
Mailing Address - Phone:225-757-1084
Mailing Address - Fax:225-757-0294
Practice Address - Street 1:7049 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4320
Practice Address - Country:US
Practice Address - Phone:225-757-1084
Practice Address - Fax:225-757-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246W00000X, 261QH0100X
LA19D0990153291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1108855Medicaid
LA18290Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER