Provider Demographics
NPI:1104921626
Name:PATHOLOGY ASSOCIATES OF SOUTH TEXAS PA
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF SOUTH TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:P
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-618-0100
Mailing Address - Street 1:PO BOX 5205
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502
Mailing Address - Country:US
Mailing Address - Phone:956-618-0100
Mailing Address - Fax:956-618-0177
Practice Address - Street 1:2117 CORNERSTONE BOULEVARD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-618-0100
Practice Address - Fax:956-618-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL8493Medicare ID - Type Unspecified