Basic Information
| Provider Information | |||||||||
| NPI: | 1659320612 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAGNOSTIC HEALTH CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DIAGNOSTIC HEALTH, BATON ROUGE NORTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 INVERNESS CENTER PKWY | ||||||||
| Address2: | SUITE 425 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352424814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059814848 | ||||||||
| FaxNumber: | 2059947018 | ||||||||
| Practice Location | |||||||||
| Address1: | 8416 CUMBERLAND PL | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708066543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259273324 | ||||||||
| FaxNumber: | 2252628654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | PELKEY | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 2059814848 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X | Y | Laboratories | Physiological Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 1942651 | 05 | LA | MEDICAID |