Provider Demographics
NPI:1366440570
Name:COMMUNITY PATHOLOGY LABORATORY LLC
Entity Type:Organization
Organization Name:COMMUNITY PATHOLOGY LABORATORY LLC
Other - Org Name:COOKEVILLE PATHOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-528-2836
Mailing Address - Street 1:115 N PEACHTREE AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2546
Mailing Address - Country:US
Mailing Address - Phone:931-528-2836
Mailing Address - Fax:931-520-8650
Practice Address - Street 1:115 N PEACHTREE AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2546
Practice Address - Country:US
Practice Address - Phone:931-528-2836
Practice Address - Fax:931-520-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty