=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851391924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHOLOGY SERVICES OF TEXARKANA,LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2005
-----------------------------------------------------
Last Update Date | 01/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 TEXAS BLVD STE 500
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75501-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-792-1331
-----------------------------------------------------
Fax | 903-793-2332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 TEXAS BLVD STE 500
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75501-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-798-7124
-----------------------------------------------------
Fax | 903-793-2332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. GEORGE WILLIAM ENGLISH III
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 903-798-7124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 45D0482320
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------