Provider Demographics
NPI:1316827181
Name:PATHWAY DIAGNOSTIC LABORATORIES 2 LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:PATHWAY DIAGNOSTIC LABORATORIES 2 LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JARVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-699-6106
Mailing Address - Street 1:19269 FM 2252 STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2579
Mailing Address - Country:US
Mailing Address - Phone:678-699-6106
Mailing Address - Fax:
Practice Address - Street 1:19269 FM 2252 STE 100
Practice Address - Street 2:
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2579
Practice Address - Country:US
Practice Address - Phone:678-699-6106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory