Provider Demographics
NPI:1407099732
Name:LAKEWOOD PATHOLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:LAKEWOOD PATHOLOGY ASSOCIATES, INC.
Other - Org Name:INFORM DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP, COMPLIANCE, ETHICS & QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:SIMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-277-8700
Mailing Address - Street 1:6655 N MACARTHUR BLVD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2443
Mailing Address - Country:US
Mailing Address - Phone:214-596-7031
Mailing Address - Fax:
Practice Address - Street 1:5470 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887
Practice Address - Country:US
Practice Address - Phone:800-440-7284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABU890AMedicare PIN