Provider Demographics
NPI:1417345703
Name:LOUISIANA IVF LAB, LLC
Entity Type:Organization
Organization Name:LOUISIANA IVF LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-989-8795
Mailing Address - Street 1:206 E FARREL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7104
Mailing Address - Country:US
Mailing Address - Phone:337-989-8795
Mailing Address - Fax:337-989-8766
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 514
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5127
Practice Address - Country:US
Practice Address - Phone:225-926-6886
Practice Address - Fax:225-922-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021643291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory