Evangeline Diagnostic Center LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

19D0461630 Issued in LA

Legal business name

EVANGELINE DIAGNOSTIC CENTER LLC

Doing business as

Acadian Laboratory Services LLC

Practice address

504 Jack Miller Road, Suite 1
Ville Platte, LA 70586

Phone

(337) 363-1465

Fax

(337) 363-1418

NPI assigned

Aug 23, 2005

Last updated

Nov 21, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Terry S Wilks Jr.

Title

Owner/Ceo

Phone

(225) 448-5886

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Acadian Laboratory Services LLC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Jesse Aswell III, MD

  • Internal Medicine Physician
  • Ville Platte, LA
  • NPI 1801842141
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574294400000",
    "number": "1518950732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11842 JUSTICE AVENUE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70816",
            "telephone_number": "225-448-5886",
            "fax_number": "225-292-5956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 JACK MILLER ROAD, SUITE 1",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "70586",
            "telephone_number": "337-363-1465",
            "fax_number": "337-363-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANGELINE DIAGNOSTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2019-11-21",
        "status": "A",
        "authorized_official_last_name": "WILKS",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "225-448-5886",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "LA",
            "license": "19D0461630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "19D0461630",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "36930",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1369942",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acadian Laboratory Services LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Acadian Laboratory Services LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Evangeline Parish School Board
• Evangeline Parish School Board

• Clinical Medical Laboratory in Ville Platte, LA
• Providers in Ville Platte, LA by specialty
• Clinical Medical Laboratory in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.