Provider Demographics
NPI:1427195882
Name:VICKSBURG PATHOLOGY LABORATORY
Entity Type:Organization
Organization Name:VICKSBURG PATHOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WHATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-445-6789
Mailing Address - Street 1:1911 MISSION 66
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3762
Mailing Address - Country:US
Mailing Address - Phone:601-629-9940
Mailing Address - Fax:601-629-9930
Practice Address - Street 1:1911 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3762
Practice Address - Country:US
Practice Address - Phone:601-629-9940
Practice Address - Fax:601-629-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory