Provider Demographics
NPI:1679902738
Name:SOUTHEASTERN CARDIOVASCULAR LAB SERVICES
Entity Type:Organization
Organization Name:SOUTHEASTERN CARDIOVASCULAR LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-767-1151
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 8000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-767-1151
Mailing Address - Fax:225-761-2676
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 8000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-767-1151
Practice Address - Fax:225-761-2676
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN CARDIOVASCULAR CONSULTANTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory