Basic Information
| Provider Information | |||||||||
| NPI: | 1700119542 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PYRAMID RESOURCES ENTERPRISES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | POSITIVE LIVING LABORTARY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3330 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048272701 | ||||||||
| FaxNumber: | 5048272715 | ||||||||
| Practice Location | |||||||||
| Address1: | 3330 CANAL ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701196246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048272701 | ||||||||
| FaxNumber: | 5048272715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2009 | ||||||||
| LastUpdateDate: | 09/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | MOGILLES | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | MARGARET | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5048272701 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 19D1081793 | LA | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 1942496310 | 01 | MA | MEDICARE NPI | OTHER |