Healthcare Provider Details

I. General information

NPI: 1184685513
Provider Name (Legal Business Name): MIDLAND PATHOLOGISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ROSALIND REDFERN GROVER PARKWAY
MIDLAND TX
79701-5846
US

IV. Provider business mailing address

5700 SOUTHWYCK BLVD
TOLEDO OH
43614-1509
US

V. Phone/Fax

Practice location:
  • Phone: 432-685-1111
  • Fax: 432-683-2616
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 Number
License Number State

VIII. Authorized Official

Name: PHILLIP A CONLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 432-685-1111