Healthcare Provider Details

I. General information

NPI: 1164781985
Provider Name (Legal Business Name): CLEAR LAKE PATHOLOGY PARTNERS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 EMMETT F LOWRY EXPY DEPARTMENT OF PATHOLOGY
TEXAS CITY TX
77591-2500
US

IV. Provider business mailing address

PO BOX 744127
DALLAS TX
75374-4127
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-3208
  • Fax: 281-338-3427
Mailing address:
  • Phone: 281-338-3208
  • Fax:

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: MARION M. RUNDELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 281-338-3208