Basic Information
| Provider Information | |||||||||
| NPI: | 1548291784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. MARY'S PATHOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 SOUTHWYCK BLVD | ||||||||
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| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436141509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002888325 | ||||||||
| FaxNumber: | 4198665453 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 STANYAN ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941171019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157505750 | ||||||||
| FaxNumber: | 4157508123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 06/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | MULHOLLAND | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | DR. | ||||||||
| AuthorizedOfficialTelephone: | 8002888325 | ||||||||
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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 | 291U00000X | G58290 | CA | N | Laboratories | Clinical Medical Laboratory | 291U00000X | G12242 | CA | N | Laboratories | Clinical Medical Laboratory | 207ZP0105X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
No ID Information.