Provider Demographics
NPI:1609901149
Name:SEGUIN PATHOLOGY SERVICES, P.A.
Entity Type:Organization
Organization Name:SEGUIN PATHOLOGY SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GRIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-372-4830
Mailing Address - Street 1:1255 ASHBY ST STE B
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5100
Mailing Address - Country:US
Mailing Address - Phone:830-372-4830
Mailing Address - Fax:830-372-9898
Practice Address - Street 1:1255 ASHBY ST STE B
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5100
Practice Address - Country:US
Practice Address - Phone:830-372-4830
Practice Address - Fax:830-372-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6687291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL8062Medicare ID - Type Unspecified