Basic Information
| Provider Information | |||||||||
| NPI: | 1710964580 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEMC PATHOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191850 | ||||||||
| Address2: | ATTN DEBBIE STRAUSS | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631197850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148218055 | ||||||||
| FaxNumber: | 3148211833 | ||||||||
| Practice Location | |||||||||
| Address1: | 1270 MERCANTILE DR | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622491256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666518747 | ||||||||
| FaxNumber: | 6186518097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GRONEMEYER | ||||||||
| AuthorizedOfficialFirstName: | PAMELLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8666518747 | ||||||||
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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 | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.