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NPI Code Detail

MEDICARE: LUFKIN ENDO PATHLOGY PLLC

MEDICARE: LUFKIN ENDO PATHLOGY 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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1942569108
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUFKIN ENDO PATHLOGY PLLC
Provider Business Mailing Address
First Line : 317 GASLIGHT BLVD
Second Line :
City : LUFKIN
State : TX
Zip : 75904-3124
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 317 GASLIGHT BLVD
Second Line :
City : LUFKIN
State : TX
Zip : 75904-3124
Country : US
Telephone Number : 936-634-3713
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. BHAGVAN MALLADI
Credential : MD
Telephone Number : 936-634-3713
Provider Enumeration Date : 05/09/2012
Last Update Date : 05/09/2012

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Directions to “LUFKIN ENDO PATHLOGY PLLC ” Practice Location

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