Provider Demographics
NPI:1437440948
Name:ONCOPATH LABORATORY, LLC
Entity Type:Organization
Organization Name:ONCOPATH LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-593-5700
Mailing Address - Street 1:4383 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3307
Mailing Address - Country:US
Mailing Address - Phone:210-593-5700
Mailing Address - Fax:210-593-5992
Practice Address - Street 1:4383 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3307
Practice Address - Country:US
Practice Address - Phone:210-593-5700
Practice Address - Fax:210-593-5992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH TEXAS ONCOLOGY AND HEMATOLOGY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory