Basic Information
| Provider Information | |||||||||
| NPI: | 1194073288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY PATHOLOGY, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 809059 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606809059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888438475 | ||||||||
| FaxNumber: | 3148496395 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 E 1ST ST | ||||||||
| Address2: | ST MARGARET'S HOSPITAL | ||||||||
| City: | SPRING VALLEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613621512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8156641470 | ||||||||
| FaxNumber: | 3148496395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2012 | ||||||||
| LastUpdateDate: | 08/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | SANTOS | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 8156641470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 036117681 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.