Provider Demographics
NPI:1497286702
Name:MARCO'P' DEE'S EXPRESS TESTING, LLC
Entity Type:Organization
Organization Name:MARCO'P' DEE'S EXPRESS TESTING, LLC
Other - Org Name:MPDET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANNESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-577-4432
Mailing Address - Street 1:3548 SILVER MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8322
Mailing Address - Country:US
Mailing Address - Phone:504-577-4432
Mailing Address - Fax:
Practice Address - Street 1:3548 SILVER MAPLE CT
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-8322
Practice Address - Country:US
Practice Address - Phone:504-577-4432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA150849261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center