Provider Demographics
NPI:1851776892
Name:AWC LAB SERVICES
Entity Type:Organization
Organization Name:AWC LAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-387-1611
Mailing Address - Street 1:150 CORA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4201
Mailing Address - Country:US
Mailing Address - Phone:225-387-1611
Mailing Address - Fax:225-343-5300
Practice Address - Street 1:150 CORA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4201
Practice Address - Country:US
Practice Address - Phone:225-387-1611
Practice Address - Fax:225-343-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19D2093699291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory