Healthcare Provider Details

I. General information

NPI: 1548370745
Provider Name (Legal Business Name): MEMPHIS PATHOLOGY LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CENTURY CENTER CV
MEMPHIS TN
38134-8975
US

IV. Provider business mailing address

1701 CENTURY CENTER CV
MEMPHIS TN
38134-8975
US

V. Phone/Fax

Practice location:
  • Phone: 901-405-8200
  • Fax: 901-328-3882
Mailing address:
  • Phone: 901-405-8200
  • Fax: 901-525-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0000003251
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number0000002069
License Number StateTN

VIII. Authorized Official

Name: MRS. DINA VALLADARES
Title or Position: SENIOR DIRECTOR
Credential:
Phone: 954-803-9405