Organization
MATTISON PATHOLOGY, L.L.P.
Active
Other names
Avero Diagnostics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY M WOLGAMOT M.D. (M.D.)
(806) 687-7284
Entity
Organization
Contact information
Practice address
4642 N LOOP 289 STE 205, LUBBOCK, TX 79416-2424
(360) 543-6836
(971) 402-0065
Mailing address
3560 MERIDIAN ST STE 101, BELLINGHAM, WA 98225-1731
(360) 734-2800
(360) 734-0426
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
291U00000X
Clinical Medical Laboratory
45D1015603
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0075KP
BLUE CROSS BLUE SHIELD
TX
05
—
1646044-01
—
TX
05
—
177874709
—
AR
01
—
45D1015603
CLIA
TX
01
—
45D1069527
CLIA
TX
01
—
7187034
COLLEGE OF AMERICAN PATHOLOGISTS
TX
01
—
7201511
COLLEGE OF AMERICAN PATHOLOGISTS
TX
05
—
72922010
—
NM
01
—
L166
FIRSTCARE
TX
Enumeration date
08/20/2006
Last updated
12/15/2025
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