Provider Demographics
NPI:1801181656
Name:PRISM PATHOLOGY LLC
Entity Type:Organization
Organization Name:PRISM PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASSAD
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-947-3500
Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:PAVILION 3, SUITE 174
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:214-941-7022
Mailing Address - Fax:214-941-5079
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAVILION 3, SUITE 174
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-941-7022
Practice Address - Fax:214-941-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory