Provider Demographics
NPI:1700861895
Name:UNIVERSITY PATHOLOGY GROUP, PC
Entity Type:Organization
Organization Name:UNIVERSITY PATHOLOGY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-448-7920
Mailing Address - Street 1:930 MADISON AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-0001
Mailing Address - Country:US
Mailing Address - Phone:901-448-7020
Mailing Address - Fax:901-448-8364
Practice Address - Street 1:930 MADISON AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0001
Practice Address - Country:US
Practice Address - Phone:901-448-7020
Practice Address - Fax:901-448-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3232291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3404362OtherGROUP PRICING NUMBER