Provider Demographics
NPI:1730486382
Name:RELIAPATH LLC A PROFESSIONAL MEDICAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:RELIAPATH LLC A PROFESSIONAL MEDICAL LIMITED LIABILITY COMPANY
Other - Org Name:RELIAPATH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-365-5944
Mailing Address - Street 1:1810 BERTRAND DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2055
Mailing Address - Country:US
Mailing Address - Phone:337-233-1899
Mailing Address - Fax:337-233-1923
Practice Address - Street 1:1810 BERTRAND DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2055
Practice Address - Country:US
Practice Address - Phone:337-233-1899
Practice Address - Fax:337-233-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty