Provider Demographics
NPI:1508915349
Name:NATCHEZ PATHOLOGY LABORATORY
Entity Type:Organization
Organization Name:NATCHEZ PATHOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-442-8171
Mailing Address - Street 1:5 STAHLMAN ST
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4612
Mailing Address - Country:US
Mailing Address - Phone:601-442-8171
Mailing Address - Fax:601-446-9403
Practice Address - Street 1:5 STAHLMAN ST
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4612
Practice Address - Country:US
Practice Address - Phone:601-442-8171
Practice Address - Fax:601-446-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1145238Medicaid
MS00013535Medicaid