Provider Demographics
NPI:1356654214
Name:TRUPATH LABORATORY LLC
Entity Type:Organization
Organization Name:TRUPATH LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:FICARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-238-9133
Mailing Address - Street 1:931 VERONE TER
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4255
Mailing Address - Country:US
Mailing Address - Phone:337-238-9133
Mailing Address - Fax:337-238-5311
Practice Address - Street 1:931 VERONE TER
Practice Address - Street 2:SUITE B
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4255
Practice Address - Country:US
Practice Address - Phone:337-238-9133
Practice Address - Fax:337-238-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
5DQ81Medicare PIN