Organization
BURRELL MOBILE LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY BURRELL (OWNER)
(504) 210-6317
Entity
Organization
Contact information
Practice address
2101 TOWER DR, MONROE, LA 71201-5045
(504) 210-6317
Mailing address
800 S 6TH ST, MONROE, LA 71202-2228
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
19D2055006
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19D2055006
—
LA
Enumeration date
03/26/2013
Last updated
03/26/2013
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