Provider Demographics
NPI:1255329413
Name:SOUTHERN OHIO REGIONAL PATHOLOGY, INC
Entity type:Organization
Organization Name:SOUTHERN OHIO REGIONAL PATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:H
Authorized Official - Last Name:RANDAISI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-356-8103
Mailing Address - Street 1:13688 US HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-8963
Mailing Address - Country:US
Mailing Address - Phone:740-356-8103
Mailing Address - Fax:
Practice Address - Street 1:1805 27TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2640
Practice Address - Country:US
Practice Address - Phone:740-356-8280
Practice Address - Fax:740-356-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9356191Medicare ID - Type Unspecified