Organization
MOBILE DIAGNOSTICS OF LAFAYETTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES C INGRAM JR. M.D. (VICE PRESIDENT)
(337) 235-0888
Entity
Organization
Contact information
Practice address
155 HOSPITAL DR, SUITE 201, LAFAYETTE, LA 70503-2852
(337) 235-0888
(337) 237-3700
Mailing address
PO BOX 52970, LAFAYETTE, LA 70505-2970
(337) 235-0888
(337) 237-3700
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F9591
BLUECROSS BLUESHIELD
LA
Enumeration date
02/06/2007
Last updated
04/25/2012
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