1780689448 NPI number — PATHOLOGY ASSOCIATES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780689448 NPI number — PATHOLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHOLOGY ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780689448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 SOUTHWYCK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43614-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-288-8325
Provider Business Mailing Address Fax Number:
419-866-5453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10010 KENNERLY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-525-4768
Provider Business Practice Location Address Fax Number:
314-525-4354
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SOTOS
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
314-525-1144

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CG4545 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123263 . This is a "BCBS MO PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 31069 . This is a "ADVANTRA PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 18289 . This is a "HEALTHCARE USA PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 31069 . This is a "GHP PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 31069 . This is a "CMR PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 459637 . This is a "HEALTHLINK PIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 502180409 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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