Provider Demographics
NPI:1629050893
Name:EAST TEXAS PATHOLOGY, P.A.
Entity Type:Organization
Organization Name:EAST TEXAS PATHOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-813-1500
Mailing Address - Street 1:PO BOX 20457
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-0457
Mailing Address - Country:US
Mailing Address - Phone:409-813-1500
Mailing Address - Fax:409-813-1133
Practice Address - Street 1:3080 MILAM ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4828
Practice Address - Country:US
Practice Address - Phone:409-813-1500
Practice Address - Fax:409-813-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCL8527Medicare ID - Type Unspecified