1649279910 NPI number — THE DELTA PATHOLOGY GROUP, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649279910 NPI number — THE DELTA PATHOLOGY GROUP, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DELTA PATHOLOGY GROUP, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649279910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2915 MISSOURI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71109-4327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-621-8820
Provider Business Mailing Address Fax Number:
318-621-9525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2915 MISSOURI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71109-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-621-8820
Provider Business Practice Location Address Fax Number:
318-621-9525
Provider Enumeration Date:
07/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FARNSLEY
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING ADMINISTRATOR
Authorized Official Telephone Number:
318-621-8820

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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