Provider Demographics
NPI:1619985488
Name:LOUISIANA MEDICAL DIAGNOSTICS
Entity Type:Organization
Organization Name:LOUISIANA MEDICAL DIAGNOSTICS
Other - Org Name:VITAL SLEEP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMARTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-222-0885
Mailing Address - Street 1:8835 LINE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6718
Mailing Address - Country:US
Mailing Address - Phone:318-222-0885
Mailing Address - Fax:318-222-0883
Practice Address - Street 1:8835 LINE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6718
Practice Address - Country:US
Practice Address - Phone:318-222-0885
Practice Address - Fax:318-222-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00171710332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1982814Medicaid
LAB2923OtherBCBS PROVIDER NUMBER
LAC8879OtherBCBS DME PROVIDER NUMBER
LA5C984Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LAC8879OtherBCBS DME PROVIDER NUMBER