Provider Demographics
NPI:1407399942
Name:PATHOS CLINICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:PATHOS CLINICAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-244-4279
Mailing Address - Street 1:8821 DAVIS BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0327
Mailing Address - Country:US
Mailing Address - Phone:281-806-9544
Mailing Address - Fax:
Practice Address - Street 1:8821 DAVIS BLVD
Practice Address - Street 2:STE 110
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0327
Practice Address - Country:US
Practice Address - Phone:281-806-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2113876291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2113876OtherCLIA