Provider Demographics
NPI:1750428223
Name:GENETIC SERVICES OF LOUISIANA
Entity type:Organization
Organization Name:GENETIC SERVICES OF LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SUPERNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-231-5381
Mailing Address - Street 1:5339 O DONOVAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-231-5381
Mailing Address - Fax:
Practice Address - Street 1:9050 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4103
Practice Address - Country:US
Practice Address - Phone:225-231-5381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty