Provider Demographics
NPI:1942641774
Name:MEDLOGIC,LLC
Entity Type:Organization
Organization Name:MEDLOGIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MALENA
Authorized Official - Middle Name:BADON
Authorized Official - Last Name:LEPETICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-319-1431
Mailing Address - Street 1:101 LA EMERGING TECHNOLOGY CTR
Mailing Address - Street 2:110 LSU UNION SQUARE
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70803-0001
Mailing Address - Country:US
Mailing Address - Phone:225-615-8970
Mailing Address - Fax:225-615-8974
Practice Address - Street 1:340 E PARKER BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4659
Practice Address - Country:US
Practice Address - Phone:225-615-8970
Practice Address - Fax:225-615-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory