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Organization

EVANGELINE DIAGNOSTIC CENTER LLC

Active
Other names
Acadian Laboratory Services LLC
Organization subpart
No

Provider details

NPI number
Authorized official
MR. TERRY S WILKS JR. (OWNER/CEO)
(225) 448-5886
Entity
Organization

Contact information

Practice address
504 JACK MILLER ROAD, SUITE 1, VILLE PLATTE, LA 70586
(337) 363-1465
(337) 363-1418
Mailing address
11842 JUSTICE AVENUE, BATON ROUGE, LA 70816
(225) 448-5886
(225) 292-5956

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
19D0461630
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1369942
LA
01
19D0461630
CLIA
LA
01
36930
BLUE CROSS BLUE SHIELD
LA
Enumeration date
08/23/2005
Last updated
11/21/2019
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