Provider Demographics
NPI:1417099227
Name:PERFORMANCE MEDICAL, INC
Entity Type:Organization
Organization Name:PERFORMANCE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-734-1927
Mailing Address - Street 1:551 HICKORY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:551 HICKORY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3104
Practice Address - Country:US
Practice Address - Phone:504-734-1927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949647Medicaid
LA1949647Medicaid