Provider Demographics
NPI:1316370950
Name:ACADIAN DIAGNOSTIC LABORATORIES LLC
Entity Type:Organization
Organization Name:ACADIAN DIAGNOSTIC LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-448-5886
Mailing Address - Street 1:11842 JUSTICE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5324
Mailing Address - Country:US
Mailing Address - Phone:225-448-5886
Mailing Address - Fax:
Practice Address - Street 1:11842 JUSTICE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5324
Practice Address - Country:US
Practice Address - Phone:225-448-5886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2352407Medicaid
19D2062876OtherCLIA
LA2352407Medicaid