Basic Information
| Provider Information | |||||||||
| NPI: | 1588651848 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMEN'S AND CHILDREN'S PATHOLOGY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52069 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705052069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372615151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4600 AMBASSADOR CAFFERY PKWY | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705086902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372615151 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | MARSHAK | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER/MD | ||||||||
| AuthorizedOfficialTelephone: | 3372615151 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 1443905 | 05 | LA | MEDICAID | CH2062 | 01 | LA | RAILROAD MEDICARE | OTHER |