Provider Demographics
NPI:1699707943
Name:ALLIANCE PATHOLOGY CONSULTANTS PA
Entity type:Organization
Organization Name:ALLIANCE PATHOLOGY CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KEAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-697-2447
Mailing Address - Street 1:PO BOX 421969
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77242-1969
Mailing Address - Country:US
Mailing Address - Phone:877-787-9677
Mailing Address - Fax:855-697-2447
Practice Address - Street 1:4000 SPENCER HWY
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1202
Practice Address - Country:US
Practice Address - Phone:713-359-1607
Practice Address - Fax:713-359-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025536601Medicaid
TXCL8374Medicare ID - Type Unspecified