Provider Demographics
NPI:1083712525
Name:ST FRANCIS PATHOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:ST FRANCIS PATHOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-900-8883
Mailing Address - Street 1:3630 E IMPERIAL HWY
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2609
Mailing Address - Country:US
Mailing Address - Phone:310-900-8615
Mailing Address - Fax:310-763-3907
Practice Address - Street 1:5856 CORPORATE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4754
Practice Address - Country:US
Practice Address - Phone:714-236-4000
Practice Address - Fax:714-236-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30735207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ47547ZOtherBLUE SHIELD
CAGR0067990Medicaid
CAHW13055Medicare PIN