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NPI Code Detail

MEDICARE: PATHOLOGY SERVICES.ORG LLC

MEDICARE: PATHOLOGY SERVICES.ORG LLC
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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1750660478
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATHOLOGY SERVICES.ORG LLC
Provider Business Mailing Address
First Line : PO BOX 10
Second Line :
City : MASON
State : MI
Zip : 48854-0010
Country : US
Telephone Number : 517-676-9788
Fax Number : 517-676-3438
Provider Business Practice Location Address
First Line : 2025 S WASHINGTON AVE
Second Line : SUITE 202
City : LANSING
State : MI
Zip : 48910-0828
Country : US
Telephone Number : 517-575-6487
Fax Number :
Authorized Official
Title or Position : TREASURER
Name : THOMAS A FAULKNER
Credential :
Telephone Number : 517-891-0441
Provider Enumeration Date : 08/11/2011
Last Update Date : 01/04/2013

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