Provider Demographics
NPI:1326133364
Name:THE LABORATORY OF LEESVILLE, APMC
Entity Type:Organization
Organization Name:THE LABORATORY OF LEESVILLE, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:ANWAR
Authorized Official - Last Name:MOLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-239-5496
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71496-0679
Mailing Address - Country:US
Mailing Address - Phone:337-239-5496
Mailing Address - Fax:337-239-5387
Practice Address - Street 1:1020 W FERTITTA BLVD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4649
Practice Address - Country:US
Practice Address - Phone:337-239-5496
Practice Address - Fax:337-239-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12708R291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1011789Medicaid
LA2236504350OtherBCBS PROVIDER #
LA174358900OtherWORKMAN'S COMP
LA7203091OtherAETNA/US HEALTHCARE
LA174358900OtherWORKMAN'S COMP
LA=========OtherCHAMPUS/TRICARE
LA2236504350OtherBCBS PROVIDER #