Provider Demographics
NPI:1437141132
Name:NORTHSHORE PATHOLOGY SERVICES APMC
Entity Type:Organization
Organization Name:NORTHSHORE PATHOLOGY SERVICES APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-646-5060
Mailing Address - Street 1:230 W HALL AVE
Mailing Address - Street 2:PMB 400
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-2635
Mailing Address - Country:US
Mailing Address - Phone:985-785-2221
Mailing Address - Fax:985-785-1118
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5520
Practice Address - Country:US
Practice Address - Phone:985-646-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1943533Medicaid
LA5D548Medicare ID - Type Unspecified