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1235186800

NPI Code Detail

MEDICARE: PATHGROUP LABS, LLC

MEDICARE: PATHGROUP LABS, LLC

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
2	291U00000X	Clinical Medical Laboratory	4052	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	P00000604	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220815100	OTHER	KY	PASSPORT ADVANTAGE
2	6345016	OTHER		CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	610609600	OTHER		US DEPT OF LABOR
5	7375469	OTHER		AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	C93014	OTHER		CUMBERLAND HEALTHCARE
9	100042158	OTHER	TN	PHP TENNCARE
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	50001168	OTHER	KY	PASSPORT
14	TN0100	OTHER	TN	JOHN DEERE HERITAGE
15	4056486	OTHER	TN	BLUE SHIELD
16	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235186800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHGROUP LABS, LLC

Provider Business Mailing Address
First Line	:	5301 VIRGINIA WAY
Second Line	:	SUITE 300
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7541
Country	:	US
Telephone Number	:	615-221-4474
Fax Number	:	615-234-3774

Provider Business Practice Location Address
First Line	:	1010 AIRPARK CENTER DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-5200
Country	:	US
Telephone Number	:	615-221-4474
Fax Number	:	615-234-3774

Authorized Official
Title or Position	:	SVP, REVENUE CYCLE MANAGEMENT
Name	:	MATTHEW WALKER
Credential	:
Telephone Number	:	615-221-4400

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/26/2025

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Directions to “PATHGROUP LABS, LLC ” Practice Location

Language	Start Address	Practice Location

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