Organization
J L COSTIN, MD, PC
Active
Other names
Physicians Pathology Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUE E COSTIN (DIRECTOR OF OPERATIONS)
(573) 785-8405
Entity
Organization
Contact information
Practice address
3069 N WESTWOOD BLVD, STE A, POPLAR BLUFF, MO 63901
(573) 785-8405
(573) 778-0425
Mailing address
PO BOX 4057, POPLAR BLUFF, MO 63902-4057
(573) 785-8405
(573) 778-0425
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114817
HEALTHLINK
MO
01
—
119564
BLUE CROSS BLUE SHIELD
MO
01
—
654990
FIRST HEALTH
MO
01
—
74954
BLUE CROSS BLUE SHIELD AL
MO
01
—
98839
ARK FIRST SOURCE
AR
01
—
98839
ARKANSAS FIRST SOURCE
MO
01
—
P00199451
RAILROAD MEDICARE
MO
Enumeration date
01/10/2007
Last updated
11/28/2007
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