MEDICARE: INTEGRATED PATHOLOGY SERVICES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	246QC2700X	Cytotechnology Specialist/Technologist
2	246QH0000X	Hematology Specialist/Technologist
3	246QH0600X	Histology Specialist/Technologist
4	246QL0900X	Laboratory Management Specialist/Technologist
5	246R00000X	Pathology Technician
6	246RH0600X	Histology Technician
7	246RM2200X	Medical Laboratory Technician
8	246Q00000X	Pathology Specialist/Technologist

General Provider Information

NPI Number	:	1871754192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED PATHOLOGY SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 7820
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95267-0820
Country	:	US
Telephone Number	:	209-477-4432
Fax Number	:	209-477-8730

Provider Business Practice Location Address
First Line	:	2291 W MARCH LN
Second Line	:	SUITE E101
City	:	STOCKTON
State	:	CA
Zip	:	95207-6652
Country	:	US
Telephone Number	:	209-477-4432
Fax Number	:	209-477-8730

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEPHEN N STORM
Credential	:
Telephone Number	:	209-477-4432

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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