MEDICARE: PATHOLOGY PROFESSIONAL SERVICES PA

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	:	1902846868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGY PROFESSIONAL SERVICES PA

Provider Business Mailing Address
First Line	:	5959 GATEWAY WEST
Second Line	:	STE 120
City	:	EL PASO
State	:	TX
Zip	:	79925-3315
Country	:	US
Telephone Number	:	915-779-1716
Fax Number	:	915-771-6558

Provider Business Practice Location Address
First Line	:	1301 RIVER
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4816
Country	:	US
Telephone Number	:	915-533-3000
Fax Number	:	915-533-5544

Authorized Official
Title or Position	:	OWNER
Name	:	JORGE BILBAO
Credential	:	MD
Telephone Number	:	915-533-3000

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/22/2020

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Directions to “PATHOLOGY PROFESSIONAL SERVICES PA ” Practice Location

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