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General NPI Number Information
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NPI Number | 1275812448
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Entity Type | Organization
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Legal Business Name | SOUTHERN PATHOLOGY A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 67241 INDUSTRY LN
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City | COVINGTON
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State | LA
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Zip | 70433-8705
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Country | US
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Telephone | 985-898-2754
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Fax | 985-898-2624
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Provider Business Mailing Address
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Address Line | 67241 INDUSTRY LN
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City | COVINGTON
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State | LA
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Zip | 70433-8705
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Country | US
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Telephone | 985-898-2754
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Fax | 985-898-2624
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAMELA M BARTHOLOMEW
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Credential | M.D.
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Telephone | 985-898-2754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | LA
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