Healthcare Provider Details

I. General information

NPI: 1609859560
Provider Name (Legal Business Name): COMPREHENSIVE PATHOLOGY SERVICES LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 BOWLES AVE
FENTON MO
63026-2394
US

IV. Provider business mailing address

PO BOX 842049
KANSAS CIY MO
64184-2049
US

V. Phone/Fax

Practice location:
  • Phone: 636-496-2720
  • Fax: 314-821-1833
Mailing address:
  • Phone: 314-821-8055
  • Fax: 314-821-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number26D0045374
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number26D0437653
License Number StateMO

VIII. Authorized Official

Name: KATHRYN LAW
Title or Position: DIRECTOR
Credential: M.D.
Phone: 314-768-8202