Provider Demographics
NPI:1912173139
Name:ACADEMIC INSTITUTE OF PATHOLOGY INC
Entity Type:Organization
Organization Name:ACADEMIC INSTITUTE OF PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:
Authorized Official - Last Name:URIBE-BOTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-663-6326
Mailing Address - Street 1:5420 BELLAIRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3957
Mailing Address - Country:US
Mailing Address - Phone:713-663-6326
Mailing Address - Fax:713-995-5914
Practice Address - Street 1:6655 HILLCROFT ST STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4815
Practice Address - Country:US
Practice Address - Phone:713-663-6326
Practice Address - Fax:713-995-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCLIA45D0722508291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0722508OtherCLIA
TXLOCL81834Medicaid
CL8183Medicare UPIN