Basic Information
| Provider Information | |||||||||
| NPI: | 1437817491 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATHOLOGY SPECIALISTS OF MEMPHIS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1211 UNION AVE STE 330 | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014780954 | ||||||||
| FaxNumber: | 9014780951 | ||||||||
| Practice Location | |||||||||
| Address1: | 1265 UNION AVE | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015167182 | ||||||||
| FaxNumber: | 9012765474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2021 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| AuthorizedOfficialLastName: | LLOYD | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER PROVIDER ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 9014780954 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZC0006X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology |
No ID Information.