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NPI Code Detail

MEDICARE: THE DELTA PATHOLOGY GROUP, L.L.C.

MEDICARE: THE DELTA PATHOLOGY GROUP, L.L.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1649279910
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE DELTA PATHOLOGY GROUP, L.L.C.
Provider Business Mailing Address
First Line : 2915 MISSOURI AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71109-4327
Country : US
Telephone Number : 318-621-8820
Fax Number : 318-621-9525
Provider Business Practice Location Address
First Line : 2915 MISSOURI AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71109-4327
Country : US
Telephone Number : 318-621-8820
Fax Number : 318-621-9525
Authorized Official
Title or Position : BILLING ADMINISTRATOR
Name : DEBBIE FARNSLEY
Credential :
Telephone Number : 318-621-8820
Provider Enumeration Date : 07/19/2005
Last Update Date : 08/22/2020

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