NPIMap

Organization Active NPI

Pathology Laboratory Associates, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Mobile, AL
National Provider Identifier
1821095167
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PATHOLOGY LABORATORY ASSOCIATES, INC.
Practice address
100 Memorial Hospital Dr Ste 1D
Mobile, AL 36608-1194
Phone
(251) 342-0030
Fax
(205) 449-3395
NPI assigned
Jul 1, 2005
Last updated
Dec 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SYNERGY LABORATORIES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Authorized official

Name
Ms. Patricia Bradley
Title
Billing Director
Phone
(251) 342-0030

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X Primary
Clinical Medical Laboratory 291U00000X 09890 AL

Addresses

Primary practice location

100 Memorial Hospital Dr Ste 1D
Mobile, AL 36608-1194

Mailing address

PO Box 160105
Mobile, AL 36616-1105
Phone (251) 342-0030

Other practice location 1

6801 Airport Blvd
Mobile, AL 36608-3709
Phone (251) 342-0030

Other identifiers 3

IdentifierTypeStateIssuer
000054172OtherALMEDICARE PAYOR ID
531500800MedicaidAL
690007138OtherALRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081002000034 AL Part B Supplier - Independent Clinical Laboratory 0749203271 Receives reassigned benefits from 6 practitioners
Practice locations: Mobile, AL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Synergy Laboratories Inc

Locations

100 Memorial Hospital Dr
Ste 1D
Mobile, AL 36608
Phone (205) 343-3484

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703203200000",
    "number": "1821095167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160105",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366161105",
            "telephone_number": "251-342-0030",
            "fax_number": "205-449-3395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEMORIAL HOSPITAL DR STE 1D",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081194",
            "telephone_number": "251-342-0030",
            "fax_number": "205-449-3395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6801 Airport Blvd",
            "address_purpose": "LOCATION",
            "city": "Mobile",
            "state": "AL",
            "postal_code": "366083709",
            "country_code": "US",
            "telephone_number": "251-342-0030",
            "fax_number": "205-449-3395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATHOLOGY LABORATORY ASSOCIATES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SYNERGY LABORATORIES, INC.",
        "enumeration_date": "2005-07-01",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-22",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "BILLING DIRECTOR",
        "authorized_official_telephone_number": "251-342-0030",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "AL",
            "license": "09890",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PAYOR ID",
            "identifier": "000054172",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "531500800",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "690007138",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; 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.