1356351225 NPI number — CENTRAL TEXAS PATHOLOGY LABORATORY, P.A.

Table of content: DR. RUCHI PARIMAL GANDHI O.D. (NPI 1306214655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356351225 NPI number — CENTRAL TEXAS PATHOLOGY LABORATORY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS PATHOLOGY LABORATORY, P.A.
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:
1356351225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76702-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-752-9621
Provider Business Mailing Address Fax Number:
254-752-8378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 W HWY 6
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76710-5591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-752-9621
Provider Business Practice Location Address Fax Number:
254-752-8378
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCTAGGART
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MANLEY
Authorized Official Title or Position:
PRESIDENT & SUPERVISING PHYSICIAN
Authorized Official Telephone Number:
254-752-9621

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 126656104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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