Healthcare Provider Details

I. General information

NPI: 1801834361
Provider Name (Legal Business Name): PATHOLOGY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 INTERNATIONAL WAY
SPRINGFIELD OR
97477
US

IV. Provider business mailing address

PO BOX 72059
SPRINGFIELD OR
97475-0285
US

V. Phone/Fax

Practice location:
  • Phone: 541-341-8033
  • Fax: 541-341-8099
Mailing address:
  • Phone: 541-222-6913
  • Fax: 541-222-6908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number38D1027898
License Number StateOR

VIII. Authorized Official

Name: JOYCE SIAMON
Title or Position: GENERAL MANAGER
Credential: MHSA
Phone: 541-341-8033