MEDICARE: LONESTAR HISTOLOGY, PLLC

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

General Provider Information

NPI Number	:	1447594809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONESTAR HISTOLOGY, PLLC

Provider Business Mailing Address
First Line	:	3418 MIDCOURT RD
Second Line	:	STE 101
City	:	CARROLLTON
State	:	TX
Zip	:	75006-4944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 MIDCOURT RD
Second Line	:	STE 101
City	:	CARROLLTON
State	:	TX
Zip	:	75006-4944
Country	:	US
Telephone Number	:	469-546-5410
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER J NAUS
Credential	:	M.D.
Telephone Number	:	469-546-5410

Provider Enumeration Date	:	11/23/2012
Last Update Date	:	11/23/2012

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