Provider Demographics
NPI:1295911527
Name:MAG LLC
Entity type:Organization
Organization Name:MAG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIZZAFFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-413-7375
Mailing Address - Street 1:8738 GRAND VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5230
Mailing Address - Country:US
Mailing Address - Phone:225-413-7375
Mailing Address - Fax:225-208-1400
Practice Address - Street 1:11737 WENTLING AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6053
Practice Address - Country:US
Practice Address - Phone:225-413-7375
Practice Address - Fax:225-208-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory