Provider Demographics
NPI:1689325490
Name:TSALEACH LAB SOLUTIONS LLC
Entity Type:Organization
Organization Name:TSALEACH LAB SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-213-4115
Mailing Address - Street 1:6163 E LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:BAY SAINT LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-8267
Mailing Address - Country:US
Mailing Address - Phone:228-213-4115
Mailing Address - Fax:
Practice Address - Street 1:6163 E LAMAR ST STE B
Practice Address - Street 2:
Practice Address - City:BAY SAINT LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-8267
Practice Address - Country:US
Practice Address - Phone:228-213-4115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory