Provider Demographics
NPI:1992857718
Name:STEPHEN PINSK, M.D., INC.
Entity Type:Organization
Organization Name:STEPHEN PINSK, M.D., INC.
Other - Org Name:PATHOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MERTENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-829-5883
Mailing Address - Street 1:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95473-1676
Mailing Address - Country:US
Mailing Address - Phone:707-829-5883
Mailing Address - Fax:707-829-5895
Practice Address - Street 1:2449 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7815
Practice Address - Country:US
Practice Address - Phone:707-829-5883
Practice Address - Fax:707-829-5895
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN PINSK, M.D., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF382291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103110Medicaid
CAGR0103110Medicaid