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
State | License ID | Taxonomies |
---|---|---|
LA | 150849 | 261Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |