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NPI Code Detail

MEDICARE: C-S AND J PATHOLOGY MEDICAL GROUP, INC.

MEDICARE: C-S AND J PATHOLOGY MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114916855
Entity Type Code : Organization
Provider Name (Legal Business Name) : C-S AND J PATHOLOGY MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 352 LINCOLN DR
Second Line :
City : VENTURA
State : CA
Zip : 93001-2322
Country : US
Telephone Number : 805-652-1516
Fax Number : 805-652-2157
Provider Business Practice Location Address
First Line : 2170 SOUTH AVE
Second Line : BARTON MEMORIAL HOSPITAL-PATHOLOGY
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-7026
Country : US
Telephone Number : 530-542-3000
Fax Number : 530-543-0124
Authorized Official
Title or Position : PRESIDENT
Name : DR. MINDY ELLEN COOPER-SMITH
Credential : M.D.
Telephone Number : 805-652-1516
Provider Enumeration Date : 10/16/2005
Last Update Date : 08/22/2020

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