Provider Demographics
NPI:1376760728
Name:D & G HOLDINGS, LLC
Entity Type:Organization
Organization Name:D & G HOLDINGS, LLC
Other - Org Name:DRS LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-390-7611
Mailing Address - Street 1:PO BOX 7161
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71137-7161
Mailing Address - Country:US
Mailing Address - Phone:318-390-7611
Mailing Address - Fax:318-949-5123
Practice Address - Street 1:8516 STODDARD ST
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:LA
Practice Address - Zip Code:71065-4607
Practice Address - Country:US
Practice Address - Phone:318-796-3894
Practice Address - Fax:318-796-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1191132Medicaid
LAP00063345OtherRAILROAD MEDICARE
LABLUE CROSS OF LAOtherPROVIDER ID
LAP00063345OtherRAILROAD MEDICARE