Provider Demographics
NPI:1649595703
Name:MOSAIC PATHOLOGY CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:MOSAIC PATHOLOGY CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-850-3582
Mailing Address - Street 1:1318 MARSH CREEK LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3940
Mailing Address - Country:US
Mailing Address - Phone:901-850-3582
Mailing Address - Fax:866-359-8798
Practice Address - Street 1:1318 MARSH CREEK LN
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3940
Practice Address - Country:US
Practice Address - Phone:901-850-3582
Practice Address - Fax:866-359-8798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOSAIC PRIME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty