Provider Demographics
NPI:1093704629
Name:EL PASO PATHOLOGY LABORATORY
Entity Type:Organization
Organization Name:EL PASO PATHOLOGY LABORATORY
Other - Org Name:PATH LAB EL PASO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WM
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-533-1300
Mailing Address - Street 1:1201 E SCHUSTER AVE
Mailing Address - Street 2:4B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4672
Mailing Address - Country:US
Mailing Address - Phone:915-533-1300
Mailing Address - Fax:915-533-1309
Practice Address - Street 1:1201 E SCHUSTER AVE
Practice Address - Street 2:4B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4672
Practice Address - Country:US
Practice Address - Phone:915-533-1300
Practice Address - Fax:915-533-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1677932Medicaid
NM77323815Medicaid
TXCL5126OtherBCBS
TX1677932Medicaid