Provider Demographics
NPI:1619900990
Name:PATHOLOGY LLC
Entity Type:Organization
Organization Name:PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BARTON
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-349-1415
Mailing Address - Street 1:PO BOX 54491
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4491
Mailing Address - Country:US
Mailing Address - Phone:504-349-1415
Mailing Address - Fax:504-349-6159
Practice Address - Street 1:1101 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3147
Practice Address - Country:US
Practice Address - Phone:504-347-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444146Medicaid
LADA5256Medicare PIN
LA1444146Medicaid
LA5CE62Medicare PIN