Provider Demographics
NPI:1396769709
Name:LAB SITE INC
Entity type:Organization
Organization Name:LAB SITE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PROVOST
Authorized Official - Suffix:
Authorized Official - Credentials:MBA HCM
Authorized Official - Phone:504-508-0734
Mailing Address - Street 1:7730 WINDWARD CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-1339
Mailing Address - Country:US
Mailing Address - Phone:504-508-0734
Mailing Address - Fax:972-291-4304
Practice Address - Street 1:86 NORTON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ARABI
Practice Address - State:LA
Practice Address - Zip Code:70032
Practice Address - Country:US
Practice Address - Phone:504-684-3347
Practice Address - Fax:504-684-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1190985Medicaid
LA1190985Medicaid
LA1190985Medicaid