=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447577150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUANTUM PATHOLOGY LABS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2010
-----------------------------------------------------
Last Update Date | 04/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1213 GENOA RED BLUFF RD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77504-4030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-592-7646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 S MAYS ST STE J151
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78664-6774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-592-7646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NAIRI ARUTYUNYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-592-7646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 45D1014951
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------