Healthcare Provider Details

I. General information

NPI: 1518211804
Provider Name (Legal Business Name): LUMINUS PATHOLOGY LABORATORY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 THOMAS RD
MEMPHIS TN
38134-6313
US

IV. Provider business mailing address

1732 THOMAS RD
MEMPHIS TN
38134-6313
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-2200
  • Fax: 901-383-2205
Mailing address:
  • Phone: 901-383-2200
  • Fax: 901-383-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. ANDRE C THOMPSON
Title or Position: OWNER
Credential: MD
Phone: 901-383-2200