Eastern Texas Pathology Laboratories, LLC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

J2242 Issued in TX

Legal business name

EASTERN TEXAS PATHOLOGY LABORATORIES, LLC

Practice address

134 Rosedale Dr
Athens, TX 75751-3625

Phone

(903) 675-0080

Fax

(903) 675-0081

NPI assigned

Mar 19, 2007

Last updated

Sep 16, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. James R. Ogburn Jr., M.D.NPI 1922088731

Title

Pathologist

Phone

(903) 675-0080

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

Tax ID family

East Texas Pathology Laboratories2 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.

• East Texas Pathology Laboratories

  • Anatomic Pathology & Clinical Pathology Physician
  • Athens, TX
  • NPI 1942437116
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James R Ogburn Jr., MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Athens, TX
  • NPI 1922088731
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410825600000",
    "number": "1154445419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 ROSEDALE DR",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "757513625",
            "telephone_number": "903-675-0080",
            "fax_number": "903-675-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 ROSEDALE DR",
            "city": "ATHENS",
            "state": "TX",
            "postal_code": "757513625",
            "telephone_number": "903-675-0080",
            "fax_number": "903-675-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN TEXAS PATHOLOGY LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2014-09-16",
        "status": "A",
        "authorized_official_last_name": "OGBURN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PATHOLOGIST",
        "authorized_official_telephone_number": "903-675-0080",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "J2242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0085PV",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• East Texas Radiological Consultants P a
• Terri Lynn Eckert, M.D.
• Jonathan D Edwards, M.D.
• Mark L Eldore, M.D.
• William Alex Elfarr, M.D.
• Elite Chiropractic Wellness Center LLC

• Anatomic Pathology & Clinical Pathology Physician in Athens, TX
• Providers in Athens, TX by specialty
• Anatomic Pathology & Clinical Pathology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2014; 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.