Provider Demographics
NPI:1194769497
Name:CLINICAL PATHOLOGY LABORATORIES, INC.
Entity type:Organization
Organization Name:CLINICAL PATHOLOGY LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SILBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-498-2105
Mailing Address - Street 1:9200 WALL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-4534
Mailing Address - Country:US
Mailing Address - Phone:512-339-1275
Mailing Address - Fax:512-873-5069
Practice Address - Street 1:9200 WALL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-4534
Practice Address - Country:US
Practice Address - Phone:512-339-1275
Practice Address - Fax:512-873-5069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0505003291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1124176Medicaid
TX025348601Medicaid
OK100758860AMedicaid
690001592OtherRAIL ROAD MEDICARE
FL031821300Medicaid
AR148650709Medicaid
NV1194769497Medicaid
OH2588490Medicaid
NM81888074Medicaid