Organization
TISSUE TECHNIQUES PATHOLOGY LABS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK L SIENA (CFO)
(972) 241-6277
Entity
Organization
Contact information
Practice address
1850 CROWN DR, SUITE # 1112, DALLAS, TX 75234-9414
(972) 241-6277
(972) 241-4747
Mailing address
1850 CROWN DR, SUITE # 1112, DALLAS, TX 75234-9414
(972) 241-6277
(972) 241-4747
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140740501
—
TX
05
—
200027600A
—
OK
01
—
4058646
BCBS
TN
01
—
CL5036
BCBS
TX
Enumeration date
11/03/2006
Last updated
03/13/2018
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