Provider Demographics
NPI:1407059801
Name:LANE RMC SERVICE CORP
Entity Type:Organization
Organization Name:LANE RMC SERVICE CORP
Other - Org Name:LANE AFTER HOURS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-654-3607
Mailing Address - Street 1:2335 CHURCH STREET
Mailing Address - Street 2:STE E
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791
Mailing Address - Country:US
Mailing Address - Phone:225-654-3607
Mailing Address - Fax:225-658-2262
Practice Address - Street 1:2335 CHURCH STREET
Practice Address - Street 2:STE E
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-654-3607
Practice Address - Fax:225-658-2262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANE REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-06
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH7716OtherBLUE CROSS LA