Provider Demographics
NPI:1518163500
Name:GILA PATHOLOGY SERVICES PA
Entity Type:Organization
Organization Name:GILA PATHOLOGY SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLISARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MD
Authorized Official - Phone:575-538-4058
Mailing Address - Street 1:1313 E. 32ND ST
Mailing Address - Street 2:LABORATORY
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-538-4058
Mailing Address - Fax:575-574-4992
Practice Address - Street 1:1313 E. 32ND ST
Practice Address - Street 2:LABORATORY
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-538-4058
Practice Address - Fax:575-574-4992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ8086Medicaid
NM500521019Medicare ID - Type Unspecified