Provider Demographics
NPI:1982681557
Name:LABORATORY PATHOLOGISTS PC
Entity Type:Organization
Organization Name:LABORATORY PATHOLOGISTS PC
Other - Org Name:PATHOLOGY LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-530-3344
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49468-0936
Mailing Address - Country:US
Mailing Address - Phone:616-530-3344
Mailing Address - Fax:616-532-8040
Practice Address - Street 1:2990 FRANKLIN AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3505
Practice Address - Country:US
Practice Address - Phone:616-530-3344
Practice Address - Fax:616-532-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207ZC0500X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory