Provider Demographics
NPI:1174577860
Name:ACCUMED OF SOUTH LOUISIANA, L.L.C.
Entity type:Organization
Organization Name:ACCUMED OF SOUTH LOUISIANA, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:225-706-1101
Mailing Address - Street 1:7385 ALBERTA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4102
Mailing Address - Country:US
Mailing Address - Phone:225-706-1101
Mailing Address - Fax:225-663-6778
Practice Address - Street 1:7385 ALBERTA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4102
Practice Address - Country:US
Practice Address - Phone:225-706-1101
Practice Address - Fax:225-663-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1000686651293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CA75Medicare ID - Type UnspecifiedIDTF