Organization
CENTRAL TEXAS PATHOLOGY LABORATORY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID MANLEY MCTAGGART M.D. (PRESIDENT & SUPERVISING PHYSICIAN)
(254) 752-9621
Entity
Organization
Contact information
Practice address
601 W HWY 6, SUITE 111, WACO, TX 76710-5591
(254) 752-9621
(254) 752-8378
Mailing address
PO BOX 21509, WACO, TX 76702-1509
(254) 752-9621
(254) 752-8378
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126656104
—
TX
Enumeration date
08/09/2006
Last updated
12/30/2008
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