1548221153 NPI number — MANGINI LAKHIA PATHOLOGY LABORATORY

Table of content: (NPI 1548221153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548221153 NPI number — MANGINI LAKHIA PATHOLOGY LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANGINI LAKHIA PATHOLOGY LABORATORY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548221153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 733030
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-271-6881
Provider Business Mailing Address Fax Number:
713-271-6885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 BUSINESS CENTER DR
Provider Second Line Business Practice Location Address:
STE 370
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77043-2737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-271-6881
Provider Business Practice Location Address Fax Number:
713-271-6885
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GAUTHIER
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
713-271-6881

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: CL8033 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 086009001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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