Healthcare Provider Details

I. General information

NPI: 1831303593
Provider Name (Legal Business Name): SOUTH PATH LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL CENTER BLVD
WEBSTER TX
77598-4220
US

IV. Provider business mailing address

PO BOX 744127
DALLAS TX
75374-4127
US

V. Phone/Fax

Practice location:
  • Phone: 281-338-3427
  • Fax:
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: MD
Phone: 281-338-3208