=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619039708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAREDO CLINICAL PATHOLOGY SERVICES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 EAST SAUNDERS AVENUE DEPARTMENT OF PATHOLOGY
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-712-1215
-----------------------------------------------------
Fax | 956-712-1685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | LOCK BOX 2369
-----------------------------------------------------
City | LAREDO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-712-1215
-----------------------------------------------------
Fax | 956-712-1685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | AUGUSTO G RAMOS JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 956-712-1215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0101X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------