Provider Demographics
NPI:1750346144
Name:MOBILE PATHOLOGY GROUP, PA
Entity type:Organization
Organization Name:MOBILE PATHOLOGY GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-633-3617
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B 218
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6776
Practice Address - Country:US
Practice Address - Phone:251-633-3617
Practice Address - Fax:251-633-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7939207ZP0102X
AL13909207ZP0102X
AL00022814207ZP0102X
207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528501000Medicaid
AL528501000Medicaid