Provider Demographics
NPI:1043494685
Name:PRABHA PARTAP MD
Entity Type:Organization
Organization Name:PRABHA PARTAP MD
Other - Org Name:DBA COUNTY SURGICAL PATHOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATHOLOGIST / LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-821-0113
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 301E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-692-0117
Mailing Address - Fax:314-993-6194
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 301E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-692-0117
Practice Address - Fax:314-993-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35538291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1603OtherBLUE CROSS/BLUE SHIELD
MO11-50016OtherUNITED HEALTH CARE
MO702206707Medicaid
MO010019679OtherRAILROAD MEDICARE
MO177567OtherHEALTHLINK
MO177567OtherHEALTHLINK