MEDICARE: PATHOLOGY ASSOCIATES, PC

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CG4545	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	123263	OTHER	MO	BCBS MO PIN
3	31069	OTHER	MO	ADVANTRA PIN
4	18289	OTHER	MO	HEALTHCARE USA PIN
5	31069	OTHER	MO	GHP PIN
6	31069	OTHER	MO	CMR PIN
7	459637	OTHER	MO	HEALTHLINK PIN
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780689448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	10010 KENNERLY ROAD
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63128-2106
Country	:	US
Telephone Number	:	314-525-4768
Fax Number	:	314-525-4354

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VERONICA SOTOS
Credential	:	MD
Telephone Number	:	314-525-1144

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	08/27/2014

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