Provider Demographics
NPI:1952512733
Name:WEST BANK ULTRASOUND LABSERVICES,L.L.C
Entity Type:Organization
Organization Name:WEST BANK ULTRASOUND LABSERVICES,L.L.C
Other - Org Name:WEST BANK ULTRASOUND SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-253-9542
Mailing Address - Street 1:24730 PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764
Mailing Address - Country:US
Mailing Address - Phone:225-253-9542
Mailing Address - Fax:225-687-8395
Practice Address - Street 1:24730 PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764
Practice Address - Country:US
Practice Address - Phone:225-253-9542
Practice Address - Fax:225-687-8395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36420648K291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA=========OtherTAX ID. NUMBER