Basic Information
| Provider Information | |||||||||
| NPI: | 1285713826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LABORATORY & PATHOLOGY DIAGNOSTICS, LLC | ||||||||
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| OtherOrganizationName: | ASSOCIATED PATHOLOGY CONSULTANTS EDWARD, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPARTMENT 4387 | ||||||||
| Address2: | |||||||||
| City: | CAROL STREAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601224387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303550450 | ||||||||
| FaxNumber: | 6305273911 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 S WASHINGTON STREET | ||||||||
| Address2: | EDWARD HOSPITAL | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605667060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303550450 | ||||||||
| FaxNumber: | 6305273911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 01/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6305273460 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.