Provider Demographics
NPI:1437690849
Name:BIOSTAT LABORATORIES, LLC
Entity Type:Organization
Organization Name:BIOSTAT LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:J
Authorized Official - Last Name:KILGARLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-798-3306
Mailing Address - Street 1:1651 E 70TH ST
Mailing Address - Street 2:PMB 404
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5115
Mailing Address - Country:US
Mailing Address - Phone:318-798-3306
Mailing Address - Fax:318-798-3386
Practice Address - Street 1:9742 SAINT VINCENT AVE STE 200
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106
Practice Address - Country:US
Practice Address - Phone:318-606-6050
Practice Address - Fax:318-606-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42273804K291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory