1306820030 NPI number — S J ASSOCIATED PATHOLOGISTS, PLLC

Table of content: (NPI 1306820030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306820030 NPI number — S J ASSOCIATED PATHOLOGISTS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S J ASSOCIATED PATHOLOGISTS, PLLC
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:
1306820030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 420150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77242-0150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-559-6929
Provider Business Mailing Address Fax Number:
713-559-6928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 E 25TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77008-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-543-8808
Provider Business Practice Location Address Fax Number:
972-645-0565
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DEKMEZIAN
Authorized Official First Name:
MHAIR
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
832-274-7916

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 121678001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CP2715 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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