Pathologyservices.Org Llc
Legal Business Name
Pathologyservices.Org Llc
NPI Number
1972651818
NPI Type
Organization
Enumeration Date
01/08/2007
Specialties
(Taxonomies)Name
Code
246QB0000X
246QC2700X
246QH0600X
246QL0900X
246RM2200X
246Q00000X
246R00000X
Primary Taxonomy
No
No
No
No
No
No
No
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