Healthcare Provider Details

I. General information

NPI: 1316920309
Provider Name (Legal Business Name): THE PATHOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PALMER AVENUE
BELLEFONTAINE OH
43311
US

IV. Provider business mailing address

PO BOX 477
BELLEFONTAINE OH
43311-0477
US

V. Phone/Fax

Practice location:
  • Phone: 937-592-4015
  • Fax: 419-866-5453
Mailing address:
  • Phone: 800-288-8325
  • Fax: 419-866-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35043604
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT H DAVIS
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 937-599-7015