Provider Demographics
NPI:1952869612
Name:BAYOU TOX, LLC
Entity type:Organization
Organization Name:BAYOU TOX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-953-0127
Mailing Address - Street 1:40497 BLACK BAYOU EXT STE A
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6808
Mailing Address - Country:US
Mailing Address - Phone:225-744-9604
Mailing Address - Fax:225-208-1685
Practice Address - Street 1:40497 BLACK BAYOU EXT STE A
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6808
Practice Address - Country:US
Practice Address - Phone:225-744-9604
Practice Address - Fax:225-208-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory