Provider Demographics
NPI:1407019292
Name:DIAGNOSTIC PATHOLOGY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:DIAGNOSTIC PATHOLOGY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-842-8222
Mailing Address - Street 1:3530 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3805
Mailing Address - Country:US
Mailing Address - Phone:409-842-8222
Mailing Address - Fax:
Practice Address - Street 1:3530 FANNIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3805
Practice Address - Country:US
Practice Address - Phone:409-842-8222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121679802Medicaid
TX121679805Medicaid
TX121679801Medicaid
TX00C360Medicare PIN