MEDICARE: PATHOLOGY SERVICES 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	26D0957595	MO

General Provider Information

NPI Number	:	1437279098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGY SERVICES INC.

Provider Business Mailing Address
First Line	:	2916 S BRENTWOOD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2714
Country	:	US
Telephone Number	:	314-963-1745
Fax Number	:	314-963-1808

Provider Business Practice Location Address
First Line	:	2916 S BRENTWOOD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2714
Country	:	US
Telephone Number	:	314-963-1745
Fax Number	:	314-963-1808

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. ANGIE MARIE FOWLER
Credential	:
Telephone Number	:	314-963-1745

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/14/2015

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