Provider Demographics
NPI:1538773163
Name:REGIONAL PATHOLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:REGIONAL PATHOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-420-9555
Mailing Address - Street 1:2110 N NAVARRO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4829
Mailing Address - Country:US
Mailing Address - Phone:713-420-9555
Mailing Address - Fax:
Practice Address - Street 1:2709 N BEN WILSON ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5728
Practice Address - Country:US
Practice Address - Phone:713-420-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL PATHOLOGY ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory