Organization
PATHNET LAB INSTITUTE SOUTH
Active
Parent organization
PATHNET ESOTERIC LABORATORY INSTITUTE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PATHNET ESOTERIC LABORATORY INSTITUTE
Authorized official
MR. ALAN M KAYE (PRESIDENT CEO)
(818) 780-6300
Entity
Organization
Contact information
Practice address
2391 NE LOOP 410, MARYMONT BUSINESS CENTRE BUILDING 3 SUITE 309, SAN ANTONIO, TX 78217-5600
(818) 780-6300
(818) 781-2243
Mailing address
7247 HAYVENHURST AVE, SUITE A3, VAN NUYS, CA 91406-2871
(818) 780-6300
(818) 781-2243
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
COS800143
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0589010
IOWA MEDICAID
TX
05
—
112130800
—
WY
05
—
1670200
—
TX
01
—
269559
OR MEDICAID
TX
01
—
37000809
KY MEDICAID
TX
01
—
404539400
MD MEDICAID
CA
01
—
404539401
MD MEDICAID
TX
01
—
45D0972921
CLIA
TX
05
—
LB233CA
—
AL
Enumeration date
04/28/2008
Last updated
04/28/2008
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