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NPI Code Detail

MEDICARE: ALEXANDRIA PATHOLOGY LABORATORY, LLC

MEDICARE: ALEXANDRIA PATHOLOGY LABORATORY, LLC
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 LaboratoryLA
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2G0919OTHERLABCBSLA (ANATOMIC)
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4CT0606OTHERLAPALMETTO GBA - RRMC
511773OTHERLABCBSLA (CLINICAL)
61069922OTHERLACIGNA

General Provider Information

NPI Number : 1902887995
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALEXANDRIA PATHOLOGY LABORATORY, LLC
Provider Business Mailing Address
First Line : PO BOX 12116
Second Line : 3510 PARLIAMENT CT.
City : ALEXANDRIA
State : LA
Zip : 71315-2116
Country : US
Telephone Number : 318-443-0941
Fax Number : 318-443-5734
Provider Business Practice Location Address
First Line : 3330 MASONIC DR
Second Line : LABORATORY
City : ALEXANDRIA
State : LA
Zip : 71301-3841
Country : US
Telephone Number : 318-443-0941
Fax Number : 318-443-5734
Authorized Official
Title or Position : OWNER/PARTNER
Name : DR. SUDHA G PILLARISETTI
Credential : M.D.
Telephone Number : 318-443-0941
Provider Enumeration Date : 11/08/2005
Last Update Date : 02/10/2010

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