1649479213 NPI number — NORTH TEXAS PATHOLOGY LABORATORIES LLC

Table of content: (NPI 1649479213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649479213 NPI number — NORTH TEXAS PATHOLOGY LABORATORIES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS PATHOLOGY LABORATORIES 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:
1649479213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 226
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWLETT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75030-0226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-526-0340
Provider Business Mailing Address Fax Number:
972-996-1857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7501 LAKEVIEW PKWY
Provider Second Line Business Practice Location Address:
STE 160
Provider Business Practice Location Address City Name:
ROWLETT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75088-9322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-526-0340
Provider Business Practice Location Address Fax Number:
972-996-1857
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEONARD
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR CLIENT SERVICES
Authorized Official Telephone Number:
903-594-3700

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: CL5182 . This is a "BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 198270401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00653098 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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