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 Dept.
Houston, TX 77091-4339

Phone

(281) 618-8504

Fax

(713) 401-0770

NPI assigned

Apr 26, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Mario Cervantes-Vazquez, M.D.

Title

President / Manager Member

Phone

(832) 638-6072

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• NPG Other name

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

{
    "created_epoch": "1272240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1649597931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 W TIDWELL RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770914339",
            "telephone_number": "281-618-8515",
            "fax_number": "281-618-8634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 W TIDWELL RD",
            "address_2": "PATHOLOGY DEPT.",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770914339",
            "telephone_number": "281-618-8504",
            "fax_number": "713-401-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE PATHOLOGY GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-26",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "CERVANTES-VAZQUEZ",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "PRESIDENT / MANAGER MEMBER",
        "authorized_official_telephone_number": "832-638-6072",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "TXB104047",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "217596001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "45D2028677",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NPG",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "NPG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• 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)
• Northstar ER River Oaks LLC

• 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 21, 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.