MEDICARE: STONE OAK PATHOLOGY

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

General Provider Information

NPI Number	:	1467623561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONE OAK PATHOLOGY

Provider Business Mailing Address
First Line	:	19284 STONE OAK PKWY
Second Line	:	#106
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3473
Country	:	US
Telephone Number	:	210-268-0134
Fax Number	:	210-268-0170

Provider Business Practice Location Address
First Line	:	19284 STONE OAK PKWY
Second Line	:	#106
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3473
Country	:	US
Telephone Number	:	210-268-0134
Fax Number	:	210-268-0170

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JOANN GARCIA
Credential	:	CGC S
Telephone Number	:	210-268-0134

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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