Organization
LABORDE DIAGNOSTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KIKI M BROUSSARD (BILLING CONTRACT MANAGER)
(337) 237-3424
Entity
Organization
Contact information
Practice address
1025 KALISTE SALOOM RD, LAFAYETTE, LA 70508-4903
(337) 237-3424
(337) 981-0976
Mailing address
1025 KALISTE SALOOM RD, LAFAYETTE, LA 70508-4903
(337) 237-3424
(337) 981-0976
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942693
—
LA
01
—
300040971
MEDICARE RAILROAD RET.
LA
Enumeration date
05/24/2006
Last updated
05/24/2011
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