=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184709925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSU PATHOLOGY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2006
-----------------------------------------------------
Last Update Date | 11/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 LONDON AVE
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43040-5512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-686-4677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 LONDON AVE
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43040-5512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-686-4677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE MANAGER
-----------------------------------------------------
Name | RACHAEL LAWTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-685-9763
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZC0006X
-----------------------------------------------------
Taxonomy Name | Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------