Provider Demographics
NPI:1649479213
Name:NORTH TEXAS PATHOLOGY LABORATORIES LLC
Entity type:Organization
Organization Name:NORTH TEXAS PATHOLOGY LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CLIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-594-3700
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-0226
Mailing Address - Country:US
Mailing Address - Phone:972-526-0340
Mailing Address - Fax:972-996-1857
Practice Address - Street 1:7501 LAKEVIEW PKWY
Practice Address - Street 2:STE 160
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9322
Practice Address - Country:US
Practice Address - Phone:972-526-0340
Practice Address - Fax:972-996-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL5182OtherBLUE CROSS AND BLUE SHIELD
TX198270401Medicaid
TXP00653098OtherRAILROAD MEDICARE
TXCL1025Medicare PIN