Provider Demographics
NPI:1780392589
Name:ASC DIAGNOSTICS LLC
Entity type:Organization
Organization Name:ASC DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-606-6020
Mailing Address - Street 1:9742 SAINT VINCENT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7129
Mailing Address - Country:US
Mailing Address - Phone:318-798-3306
Mailing Address - Fax:
Practice Address - Street 1:9742 SAINT VINCENT AVE STE 100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7129
Practice Address - Country:US
Practice Address - Phone:318-798-3306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19D2242697OtherCLIA