Provider Demographics
NPI:1255924122
Name:GEAUX BLOOD MOBILE LLC MOBILE BLOOD SERVICES
Entity type:Organization
Organization Name:GEAUX BLOOD MOBILE LLC MOBILE BLOOD SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PBT INSTRUCTOR MOBILE EXAMINER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRANECE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MLA CLP ASPT PBT SR
Authorized Official - Phone:222-692-9010
Mailing Address - Street 1:59144 W W HARLEAUX ST
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-2967
Mailing Address - Country:US
Mailing Address - Phone:225-692-9010
Mailing Address - Fax:
Practice Address - Street 1:59144 W W HARLEAUX ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-2967
Practice Address - Country:US
Practice Address - Phone:225-692-9010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5853OtherBLOOD SERVICES