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General NPI Number Information
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NPI Number | 1962791509
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Entity Type | Organization
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Legal Business Name | ADVANCE PATHOLOGY SERVICES P.C.
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 8865 PROFESSIONAL DR STE 3
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City | CADILLAC
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State | MI
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Zip | 49601-8424
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Country | US
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Telephone | 231-468-2346
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Fax | 231-468-2349
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Provider Business Mailing Address
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Address Line | PO BOX 87
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City | CADILLAC
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State | MI
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Zip | 49601-0087
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Country | US
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Telephone | 231-775-0374
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Fax | 231-775-0027
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Authorized Official
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Title or Position | BILLING/CREDENTIALING AGENT
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Name | ROXANNE L DUFORT
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Credential |
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Telephone | 231-775-0374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 4301407392
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License Number State | MI
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