Provider Demographics
NPI:1952143612
Name:PATHWAY DIAGNOSTIC LABORATORIES, LLC
Entity type:Organization
Organization Name:PATHWAY DIAGNOSTIC LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAVANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-327-8393
Mailing Address - Street 1:910 GRUENE RD BLDG 5A
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0200
Mailing Address - Country:US
Mailing Address - Phone:830-327-8393
Mailing Address - Fax:
Practice Address - Street 1:910 GRUENE RD BLDG 5A
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0200
Practice Address - Country:US
Practice Address - Phone:830-327-8393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory