Provider Demographics
NPI:1871932251
Name:OUTREACH MOBILE LABS, INC
Entity type:Organization
Organization Name:OUTREACH MOBILE LABS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAIGRE
Authorized Official - Suffix:
Authorized Official - Credentials:CLP
Authorized Official - Phone:225-366-0406
Mailing Address - Street 1:1051 N 47TH ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-1342
Mailing Address - Country:US
Mailing Address - Phone:225-366-0406
Mailing Address - Fax:225-302-7078
Practice Address - Street 1:1051 N 47TH ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-1342
Practice Address - Country:US
Practice Address - Phone:225-366-0406
Practice Address - Fax:225-302-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACLP.201140-LAB291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1821167099Medicaid