Organization
PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMY HOOD LANDRY (COMPLIANCE OFFICER)
(225) 766-4999
Entity
Organization
Contact information
Practice address
5339 ODONOVAN DR, BATON ROUGE, LA 70808-4388
(225) 766-4999
(225) 767-4704
Mailing address
5339 ODONOVAN DR, BATON ROUGE, LA 70808-4388
(225) 766-4999
(225) 767-4704
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008291200
AETNA (GROUP)
—
05
—
1184781
—
LA
01
—
1794007
MEDICAID OTHER
—
01
—
231798
WELLCARE
—
01
—
CS9840
RAILROAD MEDICARE
—
Enumeration date
08/15/2019
Last updated
08/15/2019
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