MEDICARE: MAINLAND PATHOLOGY ASSOCIATES PA

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	291U00000X	Clinical Medical Laboratory

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	690009264	OTHER	TX	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1174508600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINLAND PATHOLOGY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 420998
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77242-0998
Country	:	US
Telephone Number	:	713-481-3545
Fax Number	:

Provider Business Practice Location Address
First Line	:	11949 BISSONNET ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1425
Country	:	US
Telephone Number	:	281-988-6111
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED REP
Name	:	DR. JAMEELA AHMEDUDDIN
Credential	:	M.D.
Telephone Number	:	713-481-3545

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	03/20/2009

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Directions to “MAINLAND PATHOLOGY ASSOCIATES PA ” Practice Location

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