Provider Demographics
NPI:1700512498
Name:PATHWAY PRECLINICAL SERVICES
Entity Type:Organization
Organization Name:PATHWAY PRECLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMV
Authorized Official - Phone:651-600-7044
Mailing Address - Street 1:1 VETERANS DR BLDG 49
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:763-257-3214
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR BLDG 49
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:763-257-3214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center