Provider Demographics
NPI:1447604749
Name:PROTOCOL LABS, INC
Entity Type:Organization
Organization Name:PROTOCOL LABS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-951-2400
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1227
Mailing Address - Country:US
Mailing Address - Phone:985-951-2400
Mailing Address - Fax:985-951-2404
Practice Address - Street 1:8394 RUSHING RD E
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7816
Practice Address - Country:US
Practice Address - Phone:985-951-2400
Practice Address - Fax:985-951-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA90114589291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory