| Name: | Pathology Laboratory Associates, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 12 Nov 1969 (55 years ago) |
| Entity Number: | 000-014-326 |
| Register Number: | 000014326 |
| Historical Names: |
Pathology Laboratory Associates, P.A.
|
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | 100 MEMORIAL HOSPITAL DR STE 1DMOBILE, AL 36608 |
| Principal Address ZIP Code: | 36608 |
| Principal Mailing Address: | PO BOX 160105MOBILE, AL 36616 |
| Principal Mailing Address ZIP Code: | 36616 |
| Registered Office Street Address: | 5570 RANGELINE ROADMOBILE, AL 36619 |
| Registered Office Street Address ZIP Code: | 36619 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740406131 | 2007-04-17 | 2023-12-22 | PO BOX 160105, MOBILE, AL, 366161105, US | 3719 DAUPHIN ST, MOBILE, AL, 366081753, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 251-342-0030 |
| Fax | 2054493395 |
Authorized person
| Name | PATSY L BRADLEY |
| Role | BILLING DIRECTOR |
| Phone | 2513420030 |
Taxonomy
| Taxonomy Code | 207ZP0102X - Anatomic Pathology & Clinical Pathology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | CD4053 |
| State | AL |
| Issuer | MEDICAID |
| Number | 528501350 |
| State | AL |
| Issuer | MEDICARE PAYOR NUMBER |
| Number | D813 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BILES, BRANDON | Director | 764 COLMAN AVEFAIRHOPE, AL 36532 |
| PITTS, BRAD | Director | 5570 RANGELINE ROADMOBILE, AL 36619 |
| Name | Role | Address |
|---|---|---|
| PITTS, BRAD | Agent | 5570 RANGELINE ROADMOBILE, AL 36619 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2019-10-04 | Name Change | Pathology Laboratory Associates, P.A. | Pathology Laboratory Associates, Inc. |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
