Healthcare Provider Details

I. General information

NPI: 1336255538
Provider Name (Legal Business Name): PATHOLOGY SERVICES.ORG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E PARKDALE AVE CYTOPATHOLOGY/INDEPENDENT LABORATORY
MANISTEE MI
49660-0070
US

IV. Provider business mailing address

PO BOX 70 ATT'N LISA WORLEY
MANISTEE MI
49660-0070
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number23D0981736
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code246R00000X
TaxonomyPathology Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. LISA WORLEY
Title or Position: LIMITED MEMBER/SOLE OWNER
Credential: CT,ASCP,IAC
Phone: 231-590-5030