Provider Demographics
NPI:1790679512
Name:CRESCENT CITY SURGICAL CENTRE DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:CRESCENT CITY SURGICAL CENTRE DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BOUCHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-766-9882
Mailing Address - Street 1:2805 W MALL DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1563
Mailing Address - Country:US
Mailing Address - Phone:504-766-9882
Mailing Address - Fax:
Practice Address - Street 1:2805 W MALL DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1563
Practice Address - Country:US
Practice Address - Phone:504-766-9882
Practice Address - Fax:504-504-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory