Provider Demographics
NPI:1649273459
Name:HISTOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:HISTOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-805-9955
Mailing Address - Street 1:10935 COUNTY ROAD 159
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3333
Mailing Address - Country:US
Mailing Address - Phone:903-805-9955
Mailing Address - Fax:903-839-2494
Practice Address - Street 1:22108 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1830
Practice Address - Country:US
Practice Address - Phone:586-774-4290
Practice Address - Fax:586-774-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23D0650582OtherCLIA
MI2125102Medicaid
0M56770Medicare ID - Type Unspecified