Provider Demographics
NPI:1386601581
Name:SOUTHWEST LABORATORY SERVICES INC
Entity type:Organization
Organization Name:SOUTHWEST LABORATORY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MT ASCP
Authorized Official - Phone:337-898-8454
Mailing Address - Street 1:2621 NORTH DRIVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510
Mailing Address - Country:US
Mailing Address - Phone:337-898-8454
Mailing Address - Fax:337-898-8402
Practice Address - Street 1:2621 NORTH DRIVE SUITE A
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510
Practice Address - Country:US
Practice Address - Phone:337-898-8454
Practice Address - Fax:337-898-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACLIA19D0461069291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1360881Medicaid
690004575OtherRAILROAD
LA=========0OtherBLUE CROSS OF LOUISIANA
LA18114Medicare ID - Type Unspecified