Provider Demographics
NPI:1396746855
Name:BAYOU PATHOLOGY, APMC & N. SMITH, MD, LLP
Entity type:Organization
Organization Name:BAYOU PATHOLOGY, APMC & N. SMITH, MD, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-323-1834
Mailing Address - Street 1:109 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5303
Mailing Address - Country:US
Mailing Address - Phone:318-323-1834
Mailing Address - Fax:318-323-0376
Practice Address - Street 1:401 E VAUGHN AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5950
Practice Address - Country:US
Practice Address - Phone:318-323-1834
Practice Address - Fax:318-323-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944220Medicaid
LA=========0OtherBCBSLA
LA1944220Medicaid
LA=========OtherTRICARE
LA5D710Medicare PIN