Provider Demographics
NPI:1649427824
Name:PATHOLOGY ASSOCIATES OF TYLER PA
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF TYLER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KULAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-593-0481
Mailing Address - Street 1:1726 S BECKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4465
Mailing Address - Country:US
Mailing Address - Phone:903-593-0481
Mailing Address - Fax:903-592-0555
Practice Address - Street 1:1726 S BECKHAM AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4465
Practice Address - Country:US
Practice Address - Phone:903-593-0481
Practice Address - Fax:903-592-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00HE79OtherBCBS TX
TXCP30601OtherRAILROAD MEDICARE
TX110790601Medicaid
TXCP30601OtherRAILROAD MEDICARE