Healthcare Provider Details

I. General information

NPI: 1700609864
Provider Name (Legal Business Name): COMMUNITY HEALTH PATHOLOGY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 BELT LINE RD STE 175
ADDISON TX
75001-5807
US

IV. Provider business mailing address

4006 BELT LINE RD # 185
ADDISON TX
75001-4371
US

V. Phone/Fax

Practice location:
  • Phone: 214-619-5632
  • Fax: 888-548-2767
Mailing address:
  • Phone: 214-619-5632
  • Fax:

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 Number
License Number State

VIII. Authorized Official

Name: JESSE TOVAR
Title or Position: MANAGER
Credential:
Phone: 214-619-5632