Provider Demographics
NPI:1275639007
Name:WACO PATHOLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:WACO PATHOLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & SUPERVISING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MANLY
Authorized Official - Last Name:MCTAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-752-9621
Mailing Address - Street 1:PO BOX 21509
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1509
Mailing Address - Country:US
Mailing Address - Phone:254-752-9621
Mailing Address - Fax:254-752-8378
Practice Address - Street 1:601 W HWY 6
Practice Address - Street 2:SUITE 111
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5591
Practice Address - Country:US
Practice Address - Phone:254-752-9621
Practice Address - Fax:254-752-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080204301Medicaid
TX00236KMedicare ID - Type Unspecified