Provider Demographics
NPI:1093017840
Name:CENTURY PATHOLOGY, LLC
Entity Type:Organization
Organization Name:CENTURY PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-589-6879
Mailing Address - Street 1:1415 NORTH LOOP W
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1664
Mailing Address - Country:US
Mailing Address - Phone:713-589-6879
Mailing Address - Fax:713-795-5081
Practice Address - Street 1:9150 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-3843
Practice Address - Country:US
Practice Address - Phone:713-589-6879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9353291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory