Provider Demographics
NPI:1821095167
Name:PATHOLOGY LABORATORY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PATHOLOGY LABORATORY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-342-0030
Mailing Address - Street 1:PO BOX 160105
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36616-1105
Mailing Address - Country:US
Mailing Address - Phone:251-342-0030
Mailing Address - Fax:205-449-3395
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR STE 1D
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1194
Practice Address - Country:US
Practice Address - Phone:251-342-0030
Practice Address - Fax:205-449-3395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNERGY LABORATORIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-01
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
AL09890291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000054172OtherMEDICARE PAYOR ID
AL531500800Medicaid
AL690007138OtherRAILROAD MEDICARE