Healthcare Provider Details

I. General information

NPI: 1538490966
Provider Name (Legal Business Name): OSU PATHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 COSHOCTON AVE
MOUNT VERNON OH
43050-1440
US

IV. Provider business mailing address

1330 COSHOCTON AVE
MOUNT VERNON OH
43050-1440
US

V. Phone/Fax

Practice location:
  • Phone: 740-393-5579
  • Fax:
Mailing address:
  • Phone: 740-393-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: RACHAEL LAWTON
Title or Position: CFO
Credential:
Phone: 614-685-9763