Provider Demographics
NPI:1942815964
Name:SOUTH PLAINS PATHOLOGY INC
Entity Type:Organization
Organization Name:SOUTH PLAINS PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AL KHARRAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-788-4368
Mailing Address - Street 1:5115 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3017
Mailing Address - Country:US
Mailing Address - Phone:806-788-4368
Mailing Address - Fax:806-788-4369
Practice Address - Street 1:5115 80TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3017
Practice Address - Country:US
Practice Address - Phone:806-788-4368
Practice Address - Fax:806-788-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory