MEDICARE: HISTOPATHOMETRICS

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	261QH0100X	Health Service Clinic/Center	35485	MN

General Provider Information

NPI Number	:	1760721476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HISTOPATHOMETRICS

Provider Business Mailing Address
First Line	:	2282 FIELD STONE DR
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1918
Country	:	US
Telephone Number	:	651-334-6225
Fax Number	:	651-405-3850

Provider Business Practice Location Address
First Line	:	750 MAIN ST
Second Line	:	SUITE 100
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55118-3764
Country	:	US
Telephone Number	:	651-334-6225
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. PATRICK JOSEPH PARKS
Credential	:	MD, PHD
Telephone Number	:	651-334-6225

Provider Enumeration Date	:	02/01/2013
Last Update Date	:	08/09/2013

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Directions to “HISTOPATHOMETRICS ” Practice Location

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