Northside Pathology Group PLLC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

NORTHSIDE PATHOLOGY GROUP PLLC

Practice address

510 W Tidwell Rd
Pathology / Laboratory
Houston, TX 77091-4339

Phone

(832) 443-9071

NPI assigned

Aug 9, 2010

Last updated

Apr 18, 2020By 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

Mario Cervantes-Vazquez, MDNPI 1245234616

Title

President, Manager

Phone

(281) 618-8515

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Mario Cervantes-Vazquez, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Kingwood, TX
  • NPI 1245234616
  NPD (past) Authorized official

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587168000000",
    "number": "1316252927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 W TIDWELL RD",
            "address_2": "PATHOLOGY / LABORATORY",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770914339",
            "telephone_number": "832-443-9071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 W TIDWELL RD",
            "address_2": "PATHOLOGY / LABORATORY",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770914339",
            "telephone_number": "832-443-9071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE PATHOLOGY GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-09",
        "last_updated": "2020-04-18",
        "certification_date": "2020-04-18",
        "status": "A",
        "authorized_official_last_name": "CERVANTES-VAZQUEZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "PRESIDENT, MANAGER",
        "authorized_official_telephone_number": "281-618-8515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "H7953",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northside Gastroenterology Associates PA
• Northside Health Center
• Northside Medical Clinic LLC
• Northside Medical Group, Inc
• Northside Pain Relief Center
• Northside Pathology Group, PLLC
• Northside Pharmacy LLC
• Northside Pharmacy LLC
• Northside Spine Center LLC
• Northstar Development Company (Horizon Adult Day Services)

• Anatomic Pathology & Clinical Pathology Physician in Houston, TX
• Providers in Houston, 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 Apr 18, 2020; 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.