1023384393 NPI number — VASCULAR SPECIALTY CENTER LAB

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023384393 NPI number — VASCULAR SPECIALTY CENTER LAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR SPECIALTY CENTER LAB
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023384393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8888 SUMMA AVE
Provider Second Line Business Mailing Address:
CARDIOLOGY TOWER 3RD FL STE B
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70809-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-231-5103
Provider Business Mailing Address Fax Number:
225-925-9378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8888 SUMMA AVE
Provider Second Line Business Practice Location Address:
CARDIOLOGY TOWER 3RD FL STE B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-769-4266
Provider Business Practice Location Address Fax Number:
225-819-2976
Provider Enumeration Date:
03/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
NAOMI
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
225-769-4493

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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