MEDICARE: PRECISION PATHOLOGY MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician
2	207ZP0104X	Chemical Pathology Physician
3	207ZM0300X	Medical Microbiology Physician
4	207ZN0500X	Neuropathology Physician
5	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician
6	207ZC0500X	Cytopathology Physician
7	207ZD0900X	Dermatopathology (Pathology) Physician
8	207ZH0000X	Hematology (Pathology) Physician
9	207ZI0100X	Immunopathology Physician
10	207ZP0213X	Pediatric Pathology Physician
11	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB2871	OTHER	CA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1295797355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION PATHOLOGY MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 576730
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95357-6730
Country	:	US
Telephone Number	:	209-577-1200
Fax Number	:	209-577-6517

Provider Business Practice Location Address
First Line	:	6001 NORRIS CANYON RD
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-5400
Country	:	US
Telephone Number	:	925-275-8408
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANTHONY VICTORIO
Credential	:	MD
Telephone Number	:	209-577-1200

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	11/14/2013

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