NPIMap

Organization Active NPI

J L Costin, MD, PC

Doing business as Physicians Pathology Services

  • Clinical Medical Laboratory
  • Poplar Bluff, MO
National Provider Identifier
1669522199
Registry record updated Nov 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
J L COSTIN, MD, PC
Doing business as
Physicians Pathology Services
Practice address
3069 N Westwood Blvd
Ste a
Poplar Bluff, MO 63901
Phone
(573) 785-8405
Fax
(573) 778-0425
NPI assigned
Jan 10, 2007
Last updated
Nov 28, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sue E Costin
Title
Director of Operations
Phone
(573) 785-8405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X MO Primary

Addresses

Primary practice location

3069 N Westwood Blvd
Ste a
Poplar Bluff, MO 63901

Mailing address

PO Box 4057
Poplar Bluff, MO 63902-4057
Phone (573) 785-8405

Other identifiers 7

IdentifierTypeStateIssuer
74954OtherMOBLUE CROSS BLUE SHIELD AL
119564OtherMOBLUE CROSS BLUE SHIELD
114817OtherMOHEALTHLINK
654990OtherMOFIRST HEALTH
98839OtherARARK FIRST SOURCE
98839OtherMOARKANSAS FIRST SOURCE
P00199451OtherMORAILROAD MEDICARE

Other names 1

  • Physicians Pathology Services Doing business as

National Provider Directory

National Provider Directory

Locations

3069 N Westwood Blvd
Ste A
Poplar Bluff, MO 63901
Phone (573) 785-8405

3069 N Westwood Blvd
Ste D
Poplar Bluff, MO 63901
Phone (573) 778-0889

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1669522199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4057",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639024057",
            "telephone_number": "573-785-8405",
            "fax_number": "573-778-0425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3069 N WESTWOOD BLVD",
            "address_2": "STE A",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "63901",
            "telephone_number": "573-785-8405",
            "fax_number": "573-778-0425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J L COSTIN, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "COSTIN",
        "authorized_official_first_name": "SUE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "573-785-8405",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD AL",
            "identifier": "74954",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "119564",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "114817",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "654990",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARK FIRST SOURCE",
            "identifier": "98839",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS FIRST SOURCE",
            "identifier": "98839",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00199451",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Pathology Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.