Provider Demographics
NPI:1407844848
Name:PATHOLOGY ASSOCIATES OF SAN ANTONIO, L.L.P.
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF SAN ANTONIO, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-892-3700
Mailing Address - Street 1:PO BOX 2216
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9600 DATAPOINT DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2028
Practice Address - Country:US
Practice Address - Phone:210-892-3700
Practice Address - Fax:210-617-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD89COtherBLUE CROSS BLUE SHIELD
TX00D89CMedicare ID - Type Unspecified