Provider Demographics
NPI:1902972656
Name:MGPL INC
Entity Type:Organization
Organization Name:MGPL INC
Other - Org Name:MEDICAL GROUP PATHOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-563-1800
Mailing Address - Street 1:PO BOX 25420
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-2277
Mailing Address - Country:US
Mailing Address - Phone:805-650-5910
Mailing Address - Fax:805-650-5972
Practice Address - Street 1:4181 STATE STREET
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110
Practice Address - Country:US
Practice Address - Phone:805-563-1800
Practice Address - Fax:805-569-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0920409291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0920409OtherCLIA
CAZZZ528082OtherBLUE SHIELD OF CA
CA05D0920409OtherHEALTH CARE FIN ADMIN
CALAB20409FMedicaid
CA05D0920409Medicare ID - Type Unspecified
CA05D0920409Medicare PIN