Provider Demographics
NPI:1215917588
Name:THE PATHOLOGY LABORATORY, INC.
Entity type:Organization
Organization Name:THE PATHOLOGY LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SUPPORT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:337-312-1252
Mailing Address - Street 1:830 BAYOU PINES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-436-9557
Mailing Address - Fax:337-439-3085
Practice Address - Street 1:830 BAYOU PINES DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-436-9557
Practice Address - Fax:337-439-3085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1027732Medicaid
LA19D0461807OtherCLIA
2004101OtherCAP
LA19D0461807OtherCLIA