Organization
ACADIAN DIAGNOSTIC LABORATORIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY S WILKS JR. (OWNER/CEO)
(225) 448-5886
Entity
Organization
Contact information
Practice address
2500 S DECKER LAKE BLVD STE 4, WEST VALLEY CITY, UT 84119-5782
(225) 448-5886
(225) 292-5956
Mailing address
11842 JUSTICE AVE, BATON ROUGE, LA 70816-5324
(225) 448-5886
(225) 292-5956
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
46D2114570
CLIA
UT
Enumeration date
09/29/2017
Last updated
10/25/2019
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