Provider Demographics
NPI:1982780458
Name:PATH TECH, LLC
Entity Type:Organization
Organization Name:PATH TECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:G
Authorized Official - Last Name:VOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-416-2216
Mailing Address - Street 1:1310 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4133
Mailing Address - Country:US
Mailing Address - Phone:360-416-2218
Mailing Address - Fax:360-416-2287
Practice Address - Street 1:1310 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4133
Practice Address - Country:US
Practice Address - Phone:360-416-2218
Practice Address - Fax:360-416-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB38304Medicare PIN