Provider Demographics
NPI:1457535205
Name:HILL PATHOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:HILL PATHOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-964-0458
Mailing Address - Street 1:PO BOX 1280
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1280
Mailing Address - Country:US
Mailing Address - Phone:510-964-0458
Mailing Address - Fax:510-964-0476
Practice Address - Street 1:845 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4851
Practice Address - Country:US
Practice Address - Phone:510-964-0458
Practice Address - Fax:510-964-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21192207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22134ZMedicare PIN
CA00A211920Medicare PIN