Organization
HISTOLOGY ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E. CARPENTER PHD (MANAGER)
(903) 805-9955
Entity
Organization
Contact information
Practice address
22108 HARPER AVE, SAINT CLAIR SHORES, MI 48080-1830
(586) 774-4290
(586) 774-4220
Mailing address
10935 COUNTY ROAD 159, TYLER, TX 75703-3333
(903) 805-9955
(903) 839-2494
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2125102
—
MI
01
—
23D0650582
CLIA
MI
Enumeration date
05/24/2005
Last updated
08/20/2024
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