Provider Demographics
NPI:1629115365
Name:C. GREGORY BOWLING, M.D., APMC
Entity Type:Organization
Organization Name:C. GREGORY BOWLING, M.D., APMC
Other - Org Name:MEDICAL LABORATORY OF SW LA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C.
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-564-6726
Mailing Address - Street 1:630 W PRIEN LAKE RD
Mailing Address - Street 2:SUITE B NO. 294
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-0700
Mailing Address - Country:US
Mailing Address - Phone:337-564-6726
Mailing Address - Fax:337-474-8116
Practice Address - Street 1:2739 MAGNOLIA LN
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1011
Practice Address - Country:US
Practice Address - Phone:337-564-6726
Practice Address - Fax:337-474-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1692328Medicaid
LA1692328Medicaid