Provider Demographics
NPI:1487892238
Name:LAKE AREA LABORATORIES
Entity type:Organization
Organization Name:LAKE AREA LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-493-7000
Mailing Address - Street 1:748 E BAYOU PINES DR
Mailing Address - Street 2:SUITE-B
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7184
Mailing Address - Country:US
Mailing Address - Phone:337-493-7000
Mailing Address - Fax:337-474-2255
Practice Address - Street 1:748 E BAYOU PINES DR
Practice Address - Street 2:SUITE-B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7184
Practice Address - Country:US
Practice Address - Phone:337-493-7000
Practice Address - Fax:337-474-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200573291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19D1094002OtherCLIA IDENTIFICATION NUMBER