Provider Demographics
NPI:1942284005
Name:THE VASCULAR LAB LLC
Entity Type:Organization
Organization Name:THE VASCULAR LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TECHNICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:EMORY
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:225-819-8299
Mailing Address - Street 1:7648 PICARDY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4694
Mailing Address - Country:US
Mailing Address - Phone:225-819-8299
Mailing Address - Fax:225-766-3188
Practice Address - Street 1:7648 PICARDY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4694
Practice Address - Country:US
Practice Address - Phone:225-819-8299
Practice Address - Fax:225-766-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38161293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DA69Medicare PIN