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General NPI Number Information
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NPI Number | 1942437116
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Entity Type | Organization
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Legal Business Name | EAST TEXAS PATHOLOGY LABORATORIES
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 06/18/2009
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Provider Practice Location Address
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Address Line | 134 ROSEDALE DR
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City | ATHENS
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State | TX
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Zip | 75751-3625
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Country | US
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Telephone | 903-675-0080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 730
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City | CADDO MILLS
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State | TX
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Zip | 75135-0730
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Country | US
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Telephone | 903-675-0080
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Fax |
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | MELISSA YARBROUGH
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Credential |
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Telephone | 214-536-5634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | J2242
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License Number State | TX
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