Provider Demographics
NPI:1497834295
Name:TISSUE TECHNIQUES PATHOLOGY LABS LLC
Entity Type:Organization
Organization Name:TISSUE TECHNIQUES PATHOLOGY LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-241-6277
Mailing Address - Street 1:1850 CROWN DR
Mailing Address - Street 2:SUITE # 1112
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-9414
Mailing Address - Country:US
Mailing Address - Phone:972-241-6277
Mailing Address - Fax:972-241-4747
Practice Address - Street 1:1850 CROWN DR
Practice Address - Street 2:SUITE # 1112
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-9414
Practice Address - Country:US
Practice Address - Phone:972-241-6277
Practice Address - Fax:972-241-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL5036OtherBCBS
OK200027600AMedicaid
TN4058646OtherBCBS
TX140740501Medicaid
TX140740501Medicaid