Provider Demographics
NPI:1790853109
Name:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES C ENTER PATHOLOGY DEPARTMEN
Entity Type:Organization
Organization Name:LOUISIANA STATE UNIVERSITY HEALTH SCIENCES C ENTER PATHOLOGY DEPARTMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL LABORATORY
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:COTELINGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-675-4430
Mailing Address - Street 1:5675 MIRADOR CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-4009
Mailing Address - Country:US
Mailing Address - Phone:318-675-4430
Mailing Address - Fax:318-675-4883
Practice Address - Street 1:1541 KINGS HWY
Practice Address - Street 2:CLINICAL LAB.ROOM C2-5-HOSPITAL
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71130-3932
Practice Address - Country:US
Practice Address - Phone:318-675-4430
Practice Address - Fax:318-675-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.12041R282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital