Provider Demographics
NPI:1083842041
Name:PATHSERVE
Entity Type:Organization
Organization Name:PATHSERVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARP
Authorized Official - Suffix:
Authorized Official - Credentials:CERT PATH ASSISTANT
Authorized Official - Phone:415-664-9686
Mailing Address - Street 1:963 INDUSTRIAL RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4145
Mailing Address - Country:US
Mailing Address - Phone:415-664-9686
Mailing Address - Fax:415-294-4554
Practice Address - Street 1:963 INDUSTRIAL RD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4145
Practice Address - Country:US
Practice Address - Phone:415-664-9686
Practice Address - Fax:415-294-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory