Healthcare Provider Details

I. General information

NPI: 1801912779
Provider Name (Legal Business Name): MED PATH LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N 5TH ST
LONGVIEW TX
75601-6529
US

IV. Provider business mailing address

4848 LEMMON AVE #399
DALLAS TX
75284-4459
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-8511
  • Fax: 903-757-5033
Mailing address:
  • Phone: 214-886-4700
  • Fax: 903-757-5033

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: MR. BRIAN OLIVER
Title or Position: CFO
Credential:
Phone: 214-871-8616