Provider Demographics
NPI:1336347475
Name:THOMAS L GARDINER
Entity Type:Organization
Organization Name:THOMAS L GARDINER
Other - Org Name:ACADIA LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:337-783-0961
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-0852
Mailing Address - Country:US
Mailing Address - Phone:337-783-0961
Mailing Address - Fax:337-783-0954
Practice Address - Street 1:715 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3856
Practice Address - Country:US
Practice Address - Phone:337-783-0961
Practice Address - Fax:337-783-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131563Medicaid
LA00059OtherBLUE CROSS BLUE SHIELD
LA18035Medicare PIN