Healthcare Provider Details

I. General information

NPI: 1801181656
Provider Name (Legal Business Name): PRISM PATHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N BECKLEY AVE PAVILION 3, SUITE 174
DALLAS TX
75203-1259
US

IV. Provider business mailing address

1411 N BECKLEY AVE PAVILION 3, SUITE 174
DALLAS TX
75203-1259
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-7022
  • Fax: 214-941-5079
Mailing address:
  • Phone: 214-941-7022
  • Fax: 214-941-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ASSAD JOE SAAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-947-3500