Provider Demographics
NPI:1568484582
Name:PATHOLOGISTS LABORATORY INC
Entity Type:Organization
Organization Name:PATHOLOGISTS LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-574-6540
Mailing Address - Street 1:4733 ANDREW JACKSON PKWY
Mailing Address - Street 2:STE 2C
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1365
Mailing Address - Country:US
Mailing Address - Phone:615-574-6540
Mailing Address - Fax:615-889-3971
Practice Address - Street 1:4733 ANDREW JACKSON PKWY
Practice Address - Street 2:STE 2C
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1365
Practice Address - Country:US
Practice Address - Phone:615-574-6540
Practice Address - Fax:615-889-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3108683Medicare PIN
TN3401237Medicare PIN
TN3386167Medicare PIN