Provider Demographics
NPI:1649279910
Name:THE DELTA PATHOLOGY GROUP, L.L.C.
Entity type:Organization
Organization Name:THE DELTA PATHOLOGY GROUP, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-621-8820
Mailing Address - Street 1:2915 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-4327
Mailing Address - Country:US
Mailing Address - Phone:318-621-8820
Mailing Address - Fax:318-621-9525
Practice Address - Street 1:2915 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-4327
Practice Address - Country:US
Practice Address - Phone:318-621-8820
Practice Address - Fax:318-621-9525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA18291Medicare ID - Type Unspecified