Provider Demographics
NPI:1407059777
Name:LABORATORY FOR KIDNEY PATHOLOGY INC
Entity Type:Organization
Organization Name:LABORATORY FOR KIDNEY PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-321-5729
Mailing Address - Street 1:1916 PATTERSON ST STE 501
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2153
Mailing Address - Country:US
Mailing Address - Phone:615-321-5729
Mailing Address - Fax:615-320-0377
Practice Address - Street 1:1916 PATTERSON ST STE 501
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2153
Practice Address - Country:US
Practice Address - Phone:615-321-5729
Practice Address - Fax:615-320-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1976207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1976OtherLAB LICENSE
TN44D0308047OtherCLIA
TN3370197Medicaid
TN44D0308047OtherCLIA