NPIMap

Organization Active NPI

Gulf Coast Pathology Program PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Houston, TX
National Provider Identifier
1629643069
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
GULF COAST PATHOLOGY PROGRAM PLLC
Practice address
1313 Hermann Dr
Houston, TX 77004-7005
Phone
(713) 527-5000
NPI assigned
May 26, 2021
Last updated
Sep 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

Name
Wade Kordonowy
Title
Division VP
Phone
(713) 852-1762

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

1313 Hermann Dr
Houston, TX 77004-7005

Mailing address

PO Box 746559
Atlanta, GA 30374-6559
Phone (954) 507-6780

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210719002395 TX Part B Supplier - Clinic/Group Practice 3476956194 Receives reassigned benefits from 46 practitioners
Practice locations: Webster, TX; Tomball, TX; Cypress, TX; Texas City, TX; Pearland, TX; Pasadena, TX; McAllen, TX; Houston, TX…

National Provider Directory

National Provider Directory
Tax ID family
Gulf Coast Pathology Program PLLC15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 81

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.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1629643069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746559",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746559",
            "telephone_number": "954-507-6780",
            "fax_number": "866-262-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 HERMANN DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770047005",
            "telephone_number": "713-527-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST PATHOLOGY PROGRAM PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-26",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "KORDONOWY",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "DIVISION VP",
        "authorized_official_telephone_number": "713-852-1762"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.