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General NPI Number Information
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NPI Number | 1609827484
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Entity Type | Organization
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Legal Business Name | CENTRAL REGIONAL PATHOLOGY LABORATORIES PA
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 2945 HAZELWOOD STREET SUITE 310
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City | MAPLEWOOD
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State | MN
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Zip | 55109-1244
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Country | US
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Telephone | 651-264-1521
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Fax | 651-264-1661
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Provider Business Mailing Address
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Address Line | 2945 HAZELWOOD STREET SUITE 310
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City | MAPLEWOOD
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State | MN
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Zip | 55109
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Country | US
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Telephone | 651-264-1521
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Fax | 651-264-1661
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | JAMIE LEMIEUX
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Credential |
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Telephone | 651-264-1521
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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 | PF169
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License Number State | MN
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