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Contact Information

BLACK WATER LAB LLC
4150 OLD STERLINGTON RD STE C
MONROE, LA71203-2670
 Phone: 318-410-9900
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
Indicates primary specialty

NPI Profile & details for BLACK WATER LAB LLC

NPI # 1366907701
LBN Legal business name BLACK WATER LAB LLC
Authorized official SUSAN FLUITT - (OFFICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/08/2019
Last updated 02/22/2019 - About 7 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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