Provider Demographics
NPI:1073778437
Name:UNITED PATHOLOGY INC.
Entity Type:Organization
Organization Name:UNITED PATHOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUERY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-459-1984
Mailing Address - Street 1:75 COLONIA DE SALUD
Mailing Address - Street 2:STE 200D
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2487
Mailing Address - Country:US
Mailing Address - Phone:520-459-1984
Mailing Address - Fax:520-452-1011
Practice Address - Street 1:75 COLONIA DE SALUD
Practice Address - Street 2:STE 200D
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2487
Practice Address - Country:US
Practice Address - Phone:520-459-1984
Practice Address - Fax:520-452-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWCMBFOtherMEDICARE GROUP NUMBER