Provider Demographics
NPI:1881674182
Name:HISTOPATH, INC.
Entity Type:Organization
Organization Name:HISTOPATH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-992-4211
Mailing Address - Street 1:PO BOX 3758
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3758
Mailing Address - Country:US
Mailing Address - Phone:361-992-4211
Mailing Address - Fax:
Practice Address - Street 1:4455 S PADRE ISLAND DR STE 39
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5108
Practice Address - Country:US
Practice Address - Phone:361-980-0077
Practice Address - Fax:361-992-3847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025345202Medicaid