Provider Demographics
NPI:1912357872
Name:RIVERBOAT GROUP, LLC
Entity Type:Organization
Organization Name:RIVERBOAT GROUP, LLC
Other - Org Name:VANGUARD LABS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-598-5242
Mailing Address - Street 1:1441 CANAL ST
Mailing Address - Street 2:SUITE 317
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2714
Mailing Address - Country:US
Mailing Address - Phone:504-598-5242
Mailing Address - Fax:844-942-2677
Practice Address - Street 1:2239 POYDRAS ST
Practice Address - Street 2:SUITE 214
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7561
Practice Address - Country:US
Practice Address - Phone:504-252-9992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory