Pathlab Inc

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

PATHLAB INC

Practice address

4266 Industry Drive
Suite 1
Sierra Vista, AZ 85635-2255

Phone

(520) 335-1800

Fax

(520) 335-2743

NPI assigned

Jul 19, 2013

Organization subpart

No

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

Authorized official

Name

Max Mirot, M.D.NPI 1316022411

Title

Owner

Phone

(520) 459-1984

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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

• Max S. Mirot, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Sierra Vista, AZ
  • NPI 1316022411
  NPD Authorized official
• Rosa Trinidad C Tabanda-Lichauco, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Sierra Vista, AZ
  • NPI 1922216233
  NPD (past)

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

{
    "created_epoch": "1374192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1497197461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 609",
            "city": "HEREFORD",
            "state": "AZ",
            "postal_code": "856150609",
            "telephone_number": "520-335-1800",
            "fax_number": "520-335-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4266 INDUSTRY DRIVE",
            "address_2": "SUITE 1",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352255",
            "telephone_number": "520-335-1800",
            "fax_number": "520-335-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHLAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-19",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "MIROT",
        "authorized_official_first_name": "MAX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "520-459-1984",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AZ",
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AZ",
            "license": "03D0713539",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "906255",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alyxandria Ann Paslay-Bennett, LCSW
• Patel Medical Clinic, PLLC
• Bindi Narendra Patel, DDS
• Parag Rasik Patel, M.D.
• Santsaran C Patel, MD
• Gwynn R Patterson, MD
• Jamie Leigh Patterson
• Susan Marie Payne
• Nicole Pehanich
• Madeleine Pena

• Anatomic Pathology & Clinical Pathology Physician in Sierra Vista, AZ
• Providers in Sierra Vista, AZ by specialty
• Anatomic Pathology & Clinical Pathology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.