Basic Information
| Provider Information | |||||||||
| NPI: | 1982940862 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDCOMP SCIENCES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800 | ||||||||
| Address2: | |||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707910800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255708486 | ||||||||
| FaxNumber: | 2255708487 | ||||||||
| Practice Location | |||||||||
| Address1: | 20203 MACHOST RD | ||||||||
| Address2: | |||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707917235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255708486 | ||||||||
| FaxNumber: | 2255708487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2012 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | BEASLEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 2255708486 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 19D2050143 | 01 | LA | CLIA | OTHER |