Provider Demographics
NPI:1679547749
Name:THE PATHOLOGY GROUP PC
Entity Type:Organization
Organization Name:THE PATHOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-798-2064
Mailing Address - Street 1:120 LEHANE TER APT 219
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5622
Mailing Address - Country:US
Mailing Address - Phone:305-798-2064
Mailing Address - Fax:305-692-0884
Practice Address - Street 1:5959 PARK AVE
Practice Address - Street 2:ATTN: PATHOLOGY DEPT
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5200
Practice Address - Country:US
Practice Address - Phone:901-765-2731
Practice Address - Fax:901-765-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C278Medicare PIN
TN3385810Medicare PIN