MEDICARE: MATTISON PATHOLOGY, L.L.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0500X	Cytopathology Physician
2	291U00000X	Clinical Medical Laboratory	45D1015603	TX
3	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	45D1069527	OTHER	TX	CLIA
3	L166	OTHER	TX	FIRSTCARE
4	45D1015603	OTHER	TX	CLIA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	7187034	OTHER	TX	COLLEGE OF AMERICAN PATHOLOGISTS
7	7201511	OTHER	TX	COLLEGE OF AMERICAN PATHOLOGISTS
8	0075KP	OTHER	TX	BLUE CROSS BLUE SHIELD
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093820763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTISON PATHOLOGY, L.L.P.

Provider Business Mailing Address
First Line	:	3560 MERIDIAN ST STE 101
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1731
Country	:	US
Telephone Number	:	360-734-2800
Fax Number	:	360-734-0426

Provider Business Practice Location Address
First Line	:	4642 N LOOP 289 STE 205
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-2424
Country	:	US
Telephone Number	:	360-543-6836
Fax Number	:	971-402-0065

Authorized Official
Title or Position	:	M.D.
Name	:	DR. GREGORY M WOLGAMOT
Credential	:	M.D.
Telephone Number	:	806-687-7284

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/15/2025

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Directions to “MATTISON PATHOLOGY, L.L.P. ” Practice Location

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