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General NPI Number Information
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NPI Number | 1083668123
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Entity Type | Organization
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Legal Business Name | GALESBURG PATHOLOGY GROUP, S.C.
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 695 N KELLOGG ST
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City | GALESBURG
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State | IL
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Zip | 61401-2807
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Country | US
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Telephone | 309-345-4562
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10140
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City | PEORIA
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State | IL
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Zip | 61612-0140
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD F SANTOS
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Credential | M.D.
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Telephone | 309-343-5899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State | IL
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