Healthcare Provider Details

I. General information

NPI: 1144325127
Provider Name (Legal Business Name): JRS PATHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 WHITNEY AVE # 3
GRETNA LA
70056-5011
US

IV. Provider business mailing address

PO BOX 1907
GRETNA LA
70054-1907
US

V. Phone/Fax

Practice location:
  • Phone: 504-361-3757
  • Fax: 504-361-3132
Mailing address:
  • Phone: 504-361-3757
  • Fax: 504-361-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE F RHODES
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 318-841-9522