1235186800 NPI number — PATHGROUP LABS, LLC

Table of content: (NPI 1235186800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235186800 NPI number — PATHGROUP LABS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHGROUP LABS, LLC
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:
1235186800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 VIRGINIA WAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-221-4474
Provider Business Mailing Address Fax Number:
615-234-3774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 MOCKSVILLE AVE STE 201A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28144-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-221-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUGUELET
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
CCO
Authorized Official Telephone Number:
615-221-4400

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 4052 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01455767 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4056486 . This is a "BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 6345016 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200460360A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50001168 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 610609600 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7375469 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220815100 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: C93014 . This is a "CUMBERLAND HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37000619 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 968201772A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00000604 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100042158 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3404179 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0100 . This is a "JOHN DEERE HERITAGE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7001263 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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