Provider Demographics
NPI:1205008976
Name:ST LOUIS PATHOLOGY ASSOC INC.
Entity Type:Organization
Organization Name:ST LOUIS PATHOLOGY ASSOC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-991-8015
Mailing Address - Street 1:660 OFFICE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7103
Mailing Address - Country:US
Mailing Address - Phone:314-991-8015
Mailing Address - Fax:
Practice Address - Street 1:660 OFFICE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7103
Practice Address - Country:US
Practice Address - Phone:314-991-8015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110857207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501888903Medicaid
MO000011348OtherGROUP PTAN