Provider Demographics
NPI:1356008262
Name:MISS-LOU DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:MISS-LOU DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-653-0749
Mailing Address - Street 1:131 JEFFERSON DAVIS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5143
Mailing Address - Country:US
Mailing Address - Phone:601-653-0749
Mailing Address - Fax:601-653-0751
Practice Address - Street 1:131 JEFFERSON DAVIS BLVD STE B
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5143
Practice Address - Country:US
Practice Address - Phone:601-653-0749
Practice Address - Fax:601-653-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory