Provider Demographics
NPI:1760587752
Name:CONSULTANT PATHOLOGY SERVICE, INC.
Entity Type:Organization
Organization Name:CONSULTANT PATHOLOGY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-361-3757
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70054-1907
Mailing Address - Country:US
Mailing Address - Phone:504-361-3757
Mailing Address - Fax:504-361-3132
Practice Address - Street 1:1141 WHITNEY AVE # 3
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5011
Practice Address - Country:US
Practice Address - Phone:504-361-3757
Practice Address - Fax:504-361-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131300Medicaid
MS00015045Medicaid
LA18026Medicare ID - Type Unspecified
MS00015045Medicaid
LAB63408Medicare UPIN