Provider Demographics
NPI:1730636325
Name:THE DRAW STATION LLC
Entity Type:Organization
Organization Name:THE DRAW STATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRIMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:CLS-G
Authorized Official - Phone:337-463-7535
Mailing Address - Street 1:P.O. BOX 1452
Mailing Address - Street 2:18407 JOHNNY B HALL MEM HWY
Mailing Address - City:ROSEPINE
Mailing Address - State:LA
Mailing Address - Zip Code:70659
Mailing Address - Country:US
Mailing Address - Phone:337-463-7535
Mailing Address - Fax:337-202-1897
Practice Address - Street 1:18407 JOHNNY B HALL MEM HWY
Practice Address - Street 2:
Practice Address - City:ROSEPINE
Practice Address - State:LA
Practice Address - Zip Code:70659
Practice Address - Country:US
Practice Address - Phone:337-463-7535
Practice Address - Fax:337-202-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACLP.G0073-GEN291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory