MEDICARE: PATHOLOGYSERVICES.ORG LLC

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	246Q00000X	Pathology Specialist/Technologist	4301051173 MD	MI
2	246QB0000X	Blood Banking Specialist/Technologist	4301051173	MI
3	246QC2700X	Cytotechnology Specialist/Technologist	CLM089	CA
4	246QH0600X	Histology Specialist/Technologist	4301051173 MD	MI
5	246RM2200X	Medical Laboratory Technician	4301051173 MD	MI
6	246QC2700X	Cytotechnology Specialist/Technologist		MI
7	246QH0600X	Histology Specialist/Technologist		MI
8	246QL0900X	Laboratory Management Specialist/Technologist		MI
9	246R00000X	Pathology Technician		MI
10	246RM2200X	Medical Laboratory Technician		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	303702	OTHER	MI	TENCON
2	71020000E1 1500	OTHER	MI	BCBS OF MICH FEDERAL
3	162381523463	OTHER	MI	HUMMANA

General Provider Information

NPI Number	:	1972651818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGYSERVICES.ORG LLC

Provider Business Mailing Address
First Line	:	DEPT 77225 PATHOLOGY SERVICES ORG LLC
Second Line	:	PO BOX 77000
City	:	DETROIT
State	:	MI
Zip	:	48277-0225
Country	:	US
Telephone Number	:	231-590-5030
Fax Number	:	231-889-5969

Provider Business Practice Location Address
First Line	:	1465 E PARKDALE AVE
Second Line	:	PATHOLOGY SERVICES.ORG LLC ATTN LISA WORLEY
City	:	MANISTEE
State	:	MI
Zip	:	49660
Country	:	US
Telephone Number	:	231-590-5030
Fax Number	:	231-889-8969

Authorized Official
Title or Position	:	CYTOTECHNOLOGIST PRESIDENT
Name	:	MS. LISA WORLEY
Credential	:	CT,IAC,ASCP
Telephone Number	:	231-590-5030

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	04/20/2008

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