Duckworth Pathology Group Reference Lab

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

3282 Issued in TN

Legal business name

DUCKWORTH PATHOLOGY GROUP REFERENCE LAB

Practice address

1265 Union Ave
5TH Floor Sherrod Wing
Memphis, TN 38104-3415

Phone

(901) 725-7551

Fax

(901) 725-9721

NPI assigned

Mar 21, 2012

Organization subpart

No

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

Authorized official

Name

Thomas F O'Brien, MD

Title

President

Phone

(901) 725-7551

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Med Lab2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Duckworth Pathology Group, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Memphis, TN
  • NPI 1154305779
  NPD tax ID

Locations

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1144595208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 UNION AVE",
            "address_2": "5TH FLOOR SHERROD WING",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043415",
            "telephone_number": "901-725-7551",
            "fax_number": "901-725-9721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 UNION AVE",
            "address_2": "5TH FLOOR SHERROD WING",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043415",
            "telephone_number": "901-725-7551",
            "fax_number": "901-725-9721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUCKWORTH PATHOLOGY GROUP REFERENCE LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-21",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-725-7551",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "3282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "44D0913215",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eli Duberow, BC-HIS
• Patricia Jean Dubin, MD
• Wendy M Ducham, RDH
• Erica Renee Ducking, PHARMD
• Duckworth Laboratories Inc.
• Duckworth Pathology Group, Inc.
• Duckworth Pathology Group, Inc.
• Cody Raine Duckworth, PSY.D.
• Jeremy Duckworth
• Malissa Elaine Duckworth, LCSW

• Clinical Medical Laboratory in Memphis, TN
• Providers in Memphis, TN by specialty
• Clinical Medical Laboratory in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.