Provider Demographics
NPI:1043228786
Name:PATHOLOGY ASSOC OF SOUTHWESTERN MICHIGAN, PC
Entity Type:Organization
Organization Name:PATHOLOGY ASSOC OF SOUTHWESTERN MICHIGAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-983-8495
Mailing Address - Street 1:1234 NAPIER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2112
Mailing Address - Country:US
Mailing Address - Phone:269-983-8495
Mailing Address - Fax:
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-983-8495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI029606OtherMIDWEST HEALTH PLAN
MI27511OtherCOMMUNITY CHOICE MI
MI03566OtherPRIORITY HEALTH
MIDD1008OtherRAILROAD MEDICARE
MIXX10229OtherHEALTHPLUS MI
MI0A17613OtherBLUE CROSS BLUE SHIELD
MIDD1008OtherRAILROAD MEDICARE
MIDD1008OtherRAILROAD MEDICARE