Provider Demographics
NPI:1588629919
Name:PATHOLOGY SERVICES INC.
Entity Type:Organization
Organization Name:PATHOLOGY SERVICES INC.
Other - Org Name:INTEGRATED MOLECULAR DIAGNOSTICS PATHOLOGY, INC., IMD PATH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VP/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-818-4051
Mailing Address - Street 1:1900 THE ALAMEDA
Mailing Address - Street 2:SUITE 530
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1404
Mailing Address - Country:US
Mailing Address - Phone:866-944-8050
Mailing Address - Fax:866-944-8050
Practice Address - Street 1:3017 TELEGRAPH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2049
Practice Address - Country:US
Practice Address - Phone:510-606-8787
Practice Address - Fax:866-944-8050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED MOLECULAR DIAGNOSTICS PATHOLOG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-19
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25928ZMedicare ID - Type UnspecifiedGROUP ID
CALAB58443FMedicaid