Provider Demographics
NPI:1437279098
Name:PATHOLOGY SERVICES INC.
Entity Type:Organization
Organization Name:PATHOLOGY SERVICES INC.
Other - Org Name:PSI
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-963-1745
Mailing Address - Street 1:2916 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-2714
Mailing Address - Country:US
Mailing Address - Phone:314-963-1745
Mailing Address - Fax:314-963-1808
Practice Address - Street 1:2916 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-2714
Practice Address - Country:US
Practice Address - Phone:314-963-1745
Practice Address - Fax:314-963-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO26D0957595291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL553920Medicare PIN
MODB2544Medicare PIN
ILDA8309Medicare PIN