Provider Demographics
NPI:1376874594
Name:VASCULAR SPECIALTY CENTER LAB
Entity Type:Organization
Organization Name:VASCULAR SPECIALTY CENTER LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:D
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:225-769-4493
Mailing Address - Street 1:8888 SUMMA AVE FL 3
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3720
Mailing Address - Country:US
Mailing Address - Phone:225-769-4493
Mailing Address - Fax:225-766-3144
Practice Address - Street 1:8888 SUMMA AVE FL 3
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3720
Practice Address - Country:US
Practice Address - Phone:225-769-4266
Practice Address - Fax:225-819-2976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445843Medicaid
LAP00875383OtherRAILROAD MEDICARE
LA1445843Medicaid