NPIMap

Organization Active NPI

Pathologists Bio-Medical Laboratories PLLC

  • Clinical Medical Laboratory
  • Victoria, TX
National Provider Identifier
1003411257
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PATHOLOGISTS BIO-MEDICAL LABORATORIES PLLC
Practice address
2709 N Ben Wilson St
Victoria, TX 77901-5728
Phone
(361) 575-1111
NPI assigned
Dec 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Peter Allen DysertNPI 1619903226
Title
Managing Parter
Phone
(214) 818-9122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2709 N Ben Wilson St
Victoria, TX 77901-5728

Mailing address

3600 Gaston Ave Ste 261
Dallas, TX 75246-1902
Phone (972) 966-7877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050304000156 TX Part B Supplier - Independent Clinical Laboratory 7911961677 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coppell, TX; Victoria, TX

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pathologists Bio Medica5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

7600 Better Way
Frisco, TX 75033
Phone (214) 407-5322

800 8th Ave
Ste 326
Ft Worth, TX 76104
Phone (682) 225-3075

1650 W College St
Ste 185
Grapevine, TX 76051
Phone (817) 481-1588

1000 S Beckham Ave
Fl 3
Tyler, TX 75701
Phone (903) 531-8081

1305 W Jefferson St
Ste 140
Waxahachie, TX 75165
Phone (972) 935-9095

2460 N Interstate Highway 35 E
Ste 230
Waxahachie, TX 75165
Phone (469) 764-4105

Practitioners & affiliated clinicians

Practitioners 50

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 50

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1003411257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 GASTON AVE STE 261",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461902",
            "telephone_number": "972-966-7877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2709 N BEN WILSON ST",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779015728",
            "telephone_number": "361-575-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGISTS BIO-MEDICAL LABORATORIES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "DYSERT",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "MANAGING PARTER",
        "authorized_official_telephone_number": "214-818-9122",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.