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General NPI Number Information
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NPI Number | 1407399942
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Entity Type | Organization
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Legal Business Name | PATHOS CLINICAL SOLUTIONS LLC
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 09/28/2017
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Provider Practice Location Address
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Address Line | 8821 DAVIS BLVD STE 110
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City | KELLER
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State | TX
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Zip | 76248-0327
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Country | US
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Telephone | 281-806-9544
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Fax |
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Provider Business Mailing Address
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Address Line | 8821 DAVIS BLVD STE 110
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City | KELLER
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State | TX
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Zip | 76248-0327
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Country | US
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Telephone | 281-806-9544
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WESTON BLACK
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Credential |
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Telephone | 214-244-4279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 45D2113876
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License Number State | TX
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