Provider Demographics
NPI:1992708499
Name:LEESVILLE DIAGNOSTIC CENTER LP
Entity type:Organization
Organization Name:LEESVILLE DIAGNOSTIC CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:506 S 6TH ST
Mailing Address - Street 2:STE C
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4442
Mailing Address - Country:US
Mailing Address - Phone:337-239-2992
Mailing Address - Fax:337-392-8543
Practice Address - Street 1:506 S 6TH ST
Practice Address - Street 2:STE C
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4442
Practice Address - Country:US
Practice Address - Phone:337-239-2992
Practice Address - Fax:337-392-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21485291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CP53Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER