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General NPI Number Information
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NPI Number | 1245267673
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Entity Type | Organization
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Legal Business Name | PATH LAB DIAGNOSTIC SERVICES, LLC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 3333 N SEMINARY ST
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City | GALESBURG
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State | IL
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Zip | 61401-1251
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Country | US
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Telephone | 877-861-9294
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9518
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City | PEORIA
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State | IL
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Zip | 61612-9518
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Country | US
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Telephone | 877-861-9294
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NESTOR PAMATMAT
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Credential | M.D.
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Telephone | 877-861-9294
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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 |
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