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SKINPATH DIAGNOSTICS LLC NPI 1306117460


NPI Information

NPI: 1306117460
Provider Name: SKINPATH DIAGNOSTICS LLC
Classification: Physiological Laboratory - 293D00000X
Entity Type: Organization

CLIA Number: 19D2061541

Address:
3000 KNIGHT STREET
BLDG 5 SUITE 220
SHREVEPORT, LA
ZIP 71105
Phone: (318) 841-9526
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SKINPATH DIAGNOSTICS LLC is a physiological laboratory in Shreveport, LA. The provider is a laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. SKINPATH DIAGNOSTICS LLC NPI is 1306117460. The provider is registered as an organization entity type.

The provider's business location address is:

3000 KNIGHT STREET
BLDG 5 SUITE 220
SHREVEPORT, LA
ZIP 71105
Phone: (318) 841-9526
Fax: (318) 841-9551

The provider's authorized official is Ryan J Matherne .
The authorized official title is Medical Director and has the following contact phone number (985) 446-5888.

The CLIA number assigned to this NPI record is 19D2061541 - independent with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 1/21/2012 and was last updated on 4/19/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1293D00000XPhysiological LaboratoryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11500615MEDICAIDLOUISIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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