Healthcare Provider Details

I. General information

NPI: 1972651818
Provider Name (Legal Business Name): PATHOLOGYSERVICES.ORG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E PARKDALE AVE PATHOLOGY SERVICES.ORG LLC ATTN LISA WORLEY
MANISTEE MI
49660
US

IV. Provider business mailing address

DEPT 77225 PATHOLOGY SERVICES ORG LLC PO BOX 77000
DETROIT MI
48277-0225
US

V. Phone/Fax

Practice location:
  • Phone: 231-590-5030
  • Fax: 231-889-8969
Mailing address:
  • Phone: 231-590-5030
  • Fax: 231-889-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number4301051173 MD
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code246QB0000X
TaxonomyBlood Banking Specialist/Technologist
License Number4301051173
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code246QC2700X
TaxonomyCytotechnology Specialist/Technologist
License NumberCLM089
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code246QH0600X
TaxonomyHistology Specialist/Technologist
License Number4301051173 MD
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number4301051173 MD
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code246QC2700X
TaxonomyCytotechnology Specialist/Technologist
License Number
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code246QH0600X
TaxonomyHistology Specialist/Technologist
License Number
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number StateMI
# 10
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateMI

VIII. Authorized Official

Name: MS. LISA WORLEY
Title or Position: CYTOTECHNOLOGIST PRESIDENT
Credential: CT,IAC,ASCP
Phone: 231-590-5030