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Contact Information

MATTISON PATHOLOGY, L.L.P.
4642 N LOOP 289 STE 205
LUBBOCK, TX79416-2424
 Phone: 360-543-6836
 Fax: 971-402-0065
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anatomic Pathology & Clinical Pathology

207ZP0102X 22 Physician/Pathology
 

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
 

Clinical Pathology/Laboratory Medicine

207ZP0105X 22 Physician/Pathology
 

Cytopathology

207ZC0500X 22 Physician/Pathology
Indicates primary specialty

NPI Profile & details for MATTISON PATHOLOGY, L.L.P.

NPI # 1093820763
LBN Legal business name MATTISON PATHOLOGY, L.L.P.
Authorized official GREGORY WOLGAMOT - (M.D.)
Entity Organization
Organization subpart 1 No
Enumeration date 08/20/2006
Last updated 12/15/2025 - About 6 months ago
Identifiers
TX License # 45D1015603
AR Medicaid 177874709
NM Medicaid 72922010
TX Medicaid 1646044-01
TX Other 0075KP BLUE CROSS BLUE SHIELD
TX Other 45D1015603 CLIA
TX Other 45D1069527 CLIA
TX Other 7187034 COLLEGE OF AMERICAN PATHOLOGISTS
TX Other 7201511 COLLEGE OF AMERICAN PATHOLOGISTS
TX Other L166 FIRSTCARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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