Provider Demographics
NPI:1235186800
Name:PATHGROUP LABS, LLC
Entity type:Organization
Organization Name:PATHGROUP LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-4400
Mailing Address - Street 1:5301 VIRGINIA WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7541
Mailing Address - Country:US
Mailing Address - Phone:615-221-4474
Mailing Address - Fax:615-234-3774
Practice Address - Street 1:1010 AIRPARK CENTER DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-5200
Practice Address - Country:US
Practice Address - Phone:615-221-4474
Practice Address - Fax:615-234-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
TN4052291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY220815100OtherPASSPORT ADVANTAGE
6345016OtherCIGNA
TN3404179Medicaid
610609600OtherUS DEPT OF LABOR
7375469OtherAETNA
GA968201772AMedicaid
KY37000619Medicaid
C93014OtherCUMBERLAND HEALTHCARE
TN100042158OtherPHP TENNCARE
P00000604OtherRAILROAD MEDICARE
MS01455767Medicaid
IN200460360AMedicaid
KY50001168OtherPASSPORT
TNTN0100OtherJOHN DEERE HERITAGE
TN4056486OtherBLUE SHIELD
NC7001263Medicaid
GA968201772AMedicaid