Provider Demographics
NPI:1811081797
Name:VALLEY PATHOLOGY MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:VALLEY PATHOLOGY MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-739-3039
Mailing Address - Street 1:PO BOX 744127
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-4127
Mailing Address - Country:US
Mailing Address - Phone:760-739-3039
Mailing Address - Fax:972-498-9702
Practice Address - Street 1:555 EAST VALLEY PARKWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-739-3030
Practice Address - Fax:760-739-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32544ZOtherBLUE SHIELD GROUP NUMBER
CAGR0052130Medicaid
CAGR0052131Medicaid
CACU0599Medicare PIN
CAHW7842AMedicare PIN
CAZZZ32544ZOtherBLUE SHIELD GROUP NUMBER