Provider Demographics
NPI:1407349095
Name:IMPRESSIVE DIAGNOSTICS
Entity Type:Organization
Organization Name:IMPRESSIVE DIAGNOSTICS
Other - Org Name:IMPRESSIVE DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENDALYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-209-1906
Mailing Address - Street 1:7011 READ BLVD STE I
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-2244
Mailing Address - Country:US
Mailing Address - Phone:504-209-1906
Mailing Address - Fax:
Practice Address - Street 1:7011 READ BLVD STE I
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127
Practice Address - Country:US
Practice Address - Phone:504-209-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19D2148153OtherCLINICAL LABORATORY IMPROVEMENT AMENDMENTS