Provider Demographics
NPI:1730218041
Name:CENTURION MEDICAL LLC
Entity type:Organization
Organization Name:CENTURION MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-261-2633
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-0058
Mailing Address - Country:US
Mailing Address - Phone:337-261-2633
Mailing Address - Fax:337-261-3766
Practice Address - Street 1:2701 JOHNSTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3263
Practice Address - Country:US
Practice Address - Phone:337-261-2633
Practice Address - Fax:337-261-3766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DA35Medicare PIN