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General NPI Number Information
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NPI Number | 1982681557
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Entity Type | Organization
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Legal Business Name | LABORATORY PATHOLOGISTS PC
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2990 FRANKLIN AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-3505
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Country | US
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Telephone | 616-530-3344
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Fax | 616-532-8040
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Provider Business Mailing Address
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Address Line | PO BOX 936
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City | GRANDVILLE
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State | MI
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Zip | 49468-0936
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Country | US
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Telephone | 616-530-3344
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Fax | 616-532-8040
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | RACHEL CORNELL
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Credential |
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Telephone | 616-530-3344
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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 | 207ZC0500X
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License Number State | MI
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