1114959665 NPI number — MCD PATHOLOGY LLP

Table of content: (NPI 1114959665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114959665 NPI number — MCD PATHOLOGY LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCD PATHOLOGY LLP
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:
1114959665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7777 FOREST LANE
Provider Second Line Business Mailing Address:
DEPARTMENT OF PATHOLOGY
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75230-2584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-566-7283
Provider Business Mailing Address Fax Number:
792-566-7183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 FOREST LANE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75230-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-566-7283
Provider Business Practice Location Address Fax Number:
792-566-7183
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KRUEGER
Authorized Official First Name:
JO ELLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
972-566-7283

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PM89 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 120722702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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