Active NPI
MPL Inc
- Anatomic Pathology & Clinical Pathology Physician
- Longview, TX
National Provider Identifier
1568439313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- Legal business name
- MPL INC
- Practice address
- 402 N 5TH St
Longview, TX 75601-6529 - Phone
- (903) 758-8511
- Fax
- (903) 757-5033
- NPI assigned
- Mar 1, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brian Oliver
- Title
- Cfo
- Phone
- (214) 871-8616
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cytopathology Physician | 207ZC0500X | |||
| Dermatopathology (Pathology) Physician | 207ZD0900X | |||
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | Primary |
Addresses
Primary practice location
402 N 5TH St
Longview, TX 75601-6529
Mailing address
PO Box 840127
Dallas, TX 75284-2416
Phone (214) 886-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 154357101 | Medicaid | TX |
Other names 1
- Medical and Pathology Lab
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040514001184 | TX | Part B Supplier - Clinic/Group Practice | 4183614753 |
Receives reassigned benefits from 3 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Dallas, TX |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Anatomic Pathology & Clinical Pathology Physician
- Houston, TX
- NPI 1548814353
O20040514001184
-
- Anatomic Pathology & Clinical Pathology Physician
- Dallas, TX
- NPI 1477070886
O20040514001184
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
2526 W Bellfort Ave Ste 194
Houston, TX 77054
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1711411200000",
"number": "1568439313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 840127",
"city": "DALLAS",
"state": "TX",
"postal_code": "752842416",
"telephone_number": "214-886-4700",
"fax_number": "214-871-8609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 N 5TH ST",
"city": "LONGVIEW",
"state": "TX",
"postal_code": "756016529",
"telephone_number": "903-758-8511",
"fax_number": "903-757-5033"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MPL INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-01",
"last_updated": "2024-03-26",
"certification_date": "2024-03-26",
"status": "A",
"authorized_official_last_name": "OLIVER",
"authorized_official_first_name": "BRIAN",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "214-871-8616"
},
"taxonomies": [
{
"code": "207ZC0500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pathology, Cytopathology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207ZD0900X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pathology, Dermatopathology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "154357101",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Medical and Pathology Lab",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; 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.