Healthcare Provider Details

I. General information

NPI: 1821095167
Provider Name (Legal Business Name): PATHOLOGY LABORATORY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEMORIAL HOSPITAL DR STE 1D
MOBILE AL
36608-1194
US

IV. Provider business mailing address

PO BOX 160105
MOBILE AL
36616-1105
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-0030
  • Fax: 205-449-3395
Mailing address:
  • Phone: 251-342-0030
  • Fax: 205-449-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number09890
License Number StateAL

VIII. Authorized Official

Name: MS. PATRICIA BRADLEY
Title or Position: BILLING DIRECTOR
Credential:
Phone: 251-342-0030