Organization
ILES MEDICAL TESTING,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOROTHY MARIE ILES LA,CPT,MROA (DIRECTOR)
(337) 562-0835
Entity
Organization
Contact information
Practice address
3437 DEREK DR, LAKE CHARLES, LA 70607-7533
(337) 562-0835
(337) 562-8985
Mailing address
3437 DEREK DR, LAKE CHARLES, LA 70607-7533
(337) 562-0835
(337) 562-8985
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669984183
—
LA
Enumeration date
10/25/2017
Last updated
10/20/2021
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