Provider Demographics
NPI:1548539661
Name:CARIS MOLECULAR PATHOLOGY
Entity type:Organization
Organization Name:CARIS MOLECULAR PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO AND CAO AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-294-5568
Mailing Address - Street 1:750 WEST JOHN CARPENTER FREEWAY. C/O KELLY BERMAN
Mailing Address - Street 2:SUITE 800
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2443
Mailing Address - Country:US
Mailing Address - Phone:214-294-5558
Mailing Address - Fax:214-294-5640
Practice Address - Street 1:4610 SOUTH 44TH PLACE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040
Practice Address - Country:US
Practice Address - Phone:602-464-7664
Practice Address - Fax:214-716-4125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIS MPI, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-19
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty