Provider Demographics
NPI:1558602128
Name:LABORATORY OF LOUISIANA LLC
Entity Type:Organization
Organization Name:LABORATORY OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATCHEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MORICE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:985-702-2229
Mailing Address - Street 1:1216 N VICTOR II BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1392
Mailing Address - Country:US
Mailing Address - Phone:985-702-2229
Mailing Address - Fax:985-384-0329
Practice Address - Street 1:1216 N VICTOR II BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1392
Practice Address - Country:US
Practice Address - Phone:985-702-2229
Practice Address - Fax:985-384-0329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory