Provider Demographics
NPI:1407111479
Name:PATHOLOGY, INC.
Entity Type:Organization
Organization Name:PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFRANCESCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-225-3147
Mailing Address - Street 1:19951 MARINER AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1672
Mailing Address - Country:US
Mailing Address - Phone:310-769-0561
Mailing Address - Fax:310-380-7165
Practice Address - Street 1:199 S ADDISON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1929
Practice Address - Country:US
Practice Address - Phone:877-647-1082
Practice Address - Fax:630-412-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14D2041305291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092020Medicaid
CA05D0989581Medicare PIN