Organization
PATHOLOGY REFERENCE LABORATORY, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT RUPNOW (CEO)
(210) 892-3707
Entity
Organization
Contact information
Practice address
9600 DATAPOINT DR, SAN ANTONIO, TX 78229-2028
(210) 892-3700
(210) 614-4659
Mailing address
PO BOX 2037, SAN ANTONIO, TX 78297-2037
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D0974323
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D0974323
CLIA
TX
01
—
CL5070
BLUE CROSS BLUE SHIELD
—
05
—
L0DL84554
—
TX
Enumeration date
10/10/2005
Last updated
06/18/2024
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