MEDICARE: GULF COAST PATHOLOGY ASSOCIATES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician
2	207ZC0500X	Cytopathology Physician
3	207ZF0201X	Forensic Pathology Physician
4	207ZH0000X	Hematology (Pathology) Physician
5	207ZN0500X	Neuropathology Physician
6	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336100858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GULF COAST PATHOLOGY ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	PO BOX 840127
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0127
Country	:	US
Telephone Number	:	469-886-4700
Fax Number	:	214-871-8609

Provider Business Practice Location Address
First Line	:	2525 W BELLFORT AVE STE 194
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-5099
Country	:	US
Telephone Number	:	281-661-1825
Fax Number	:	214-871-8609

Authorized Official
Title or Position	:	CFO
Name	:	BRIAN OLIVER
Credential	:
Telephone Number	:	214-871-8616

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	03/26/2024

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