MEDICARE: ARIZONA PATHOLOGY GROUP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		AZ

General Provider Information

NPI Number	:	1144383423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA PATHOLOGY GROUP INC.

Provider Business Mailing Address
First Line	:	7111 FAIRWAY DR
Second Line	:	SUITE 400
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-4204
Country	:	US
Telephone Number	:	561-712-6265
Fax Number	:	561-712-7349

Provider Business Practice Location Address
First Line	:	2755 SILVER CREEK RD
Second Line	:	SUITE 203
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7904
Country	:	US
Telephone Number	:	928-763-9077
Fax Number	:

Authorized Official
Title or Position	:	VP SECRETARY TREASURER
Name	:	MR. STEPHEN A. DILLEMUTH
Credential	:
Telephone Number	:	561-712-6200

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/22/2020

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