Organization

Pathologyservices.Org Llc

Legal Business Name

Pathologyservices.Org Llc

NPI Number

1972651818

NPI Type

Organization

Enumeration Date

01/08/2007

Licenses

State

California
Michigan
Michigan

License Number

CLM089
4301051173
4301051173 MD

Contact
Information

Purpose

Mailing
Location

Address

DEPT 77225 PATHOLOGY SERVICES ORG LLC
1465 E PARKDALE AVE

City

Detroit
Manistee

State

MI
MI

Postal Code

48277-0225
49660

Country

US
US

Telephone Number

(231) 590-5030
(231) 590-5030

Authorized Official

Name

Ms. Lisa Worley

Title or Position

CYTOTECHNOLOGIST PRESIDENT

Telephone Number

(231) 590-5030

Identifiers

Identifier

303702
71020000E1 1500
162381523463

Identifier State

MI
MI
MI

Identifier Issuer

TENCON
BCBS OF MICH FEDERAL
HUMMANA

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 04/20/2008

Provider Address