Provider Demographics
NPI:1548221153
Name:MANGINI LAKHIA PATHOLOGY LABORATORY
Entity Type:Organization
Organization Name:MANGINI LAKHIA PATHOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-271-6881
Mailing Address - Street 1:PO BOX 733030
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3025
Mailing Address - Country:US
Mailing Address - Phone:713-271-6881
Mailing Address - Fax:713-271-6885
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:STE 370
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2737
Practice Address - Country:US
Practice Address - Phone:713-271-6881
Practice Address - Fax:713-271-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
TXCL8033291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086009001Medicaid
CL8033Medicare ID - Type Unspecified