Provider Demographics
NPI:1609449941
Name:GULF COAST PATHOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:GULF COAST PATHOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LISTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:936-234-9557
Mailing Address - Street 1:1801 ROYAL LN STE 810
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3169
Mailing Address - Country:US
Mailing Address - Phone:469-886-4700
Mailing Address - Fax:
Practice Address - Street 1:1801 ROYAL LN STE 810
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-3169
Practice Address - Country:US
Practice Address - Phone:469-886-4700
Practice Address - Fax:214-871-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic PathologyGroup - Single Specialty