Provider Demographics
NPI:1700345493
Name:MID-VALLEY PATHOLOGY PLLC
Entity Type:Organization
Organization Name:MID-VALLEY PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RECAVARREN ASENCIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-854-4248
Mailing Address - Street 1:505 ANGELITA DR STE 6
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-4790
Mailing Address - Country:US
Mailing Address - Phone:956-854-4248
Mailing Address - Fax:956-520-8248
Practice Address - Street 1:505 ANGELITA DR STE 6
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-4790
Practice Address - Country:US
Practice Address - Phone:956-854-4248
Practice Address - Fax:956-520-8248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory