Provider Demographics
NPI:1548370745
Name:MEMPHIS PATHOLOGY LABORATORY
Entity type:Organization
Organization Name:MEMPHIS PATHOLOGY LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-542-6838
Mailing Address - Street 1:1701 CENTURY CENTER CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-8975
Mailing Address - Country:US
Mailing Address - Phone:901-405-8200
Mailing Address - Fax:901-525-5465
Practice Address - Street 1:1701 CENTURY CENTER CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-8975
Practice Address - Country:US
Practice Address - Phone:901-405-8200
Practice Address - Fax:901-328-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003251291U00000X
TN0000002069291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3403482Medicaid
KY7100113940Medicaid
TN3138591OtherBLUE CROSS
MS0121666Medicaid
AR139749709Medicaid