Healthcare Provider Details

I. General information

NPI: 1720055577
Provider Name (Legal Business Name): PATHOLOGY ASSOCIATION OF LONGVIEW PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EAST MARSHALL AVE
LONGVIEW TX
75601
US

IV. Provider business mailing address

PO BOX 3187
LONGVIEW TX
75606-3187
US

V. Phone/Fax

Practice location:
  • Phone: 903-315-2000
  • Fax:
Mailing address:
  • Phone: 903-758-8511
  • Fax: 903-757-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN JAMES MCQUAID
Title or Position: PRESIDENT
Credential: MD
Phone: 903-758-8511