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General NPI Number Information
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NPI Number | 1548820046
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Entity Type | Organization
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Legal Business Name | PATHEMA GX LAB, LLC
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 250 ED ENGLISH DR STE E
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City | SHENANDOAH
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State | TX
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Zip | 77385-8020
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Country | US
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Telephone | 916-716-7117
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Fax | 833-819-4910
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Provider Business Mailing Address
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Address Line | 4800 140TH AVE STE 102
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City | CLEARWATER
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State | FL
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Zip | 33762
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Country | US
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Telephone |
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Fax | 833-819-4910
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CHRISTOPHER EAVES
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Credential |
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Telephone | 916-716-7117
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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 |
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License Number State |
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