Provider Demographics
NPI:1023038536
Name:MOSAIC GASTROINTESTINAL PATHOLOGY SERVICES PLLC
Entity Type:Organization
Organization Name:MOSAIC GASTROINTESTINAL PATHOLOGY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-850-3582
Mailing Address - Street 1:1318 MARSH CREEK LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3940
Mailing Address - Country:US
Mailing Address - Phone:901-850-3582
Mailing Address - Fax:866-359-8798
Practice Address - Street 1:1318 MARSH CREEK LN
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3940
Practice Address - Country:US
Practice Address - Phone:901-850-3582
Practice Address - Fax:866-359-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD38561207ZP0102X
TXL4321207ZP0102X
TN38315207ZP0102X
LA15159R207ZP0102X
WAMD35554207ZP0102X
TN26678207ZP0102X
MS18432207ZP0102X
AL27153207ZP0102X
SC28383207ZP0102X
CODR-44161207ZP0102X
KS0431573207ZP0102X
IN01061121A207ZP0102X
NY236521207ZP0102X
UT5898862207ZP0102X
CT043452207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty