Provider Demographics
NPI:1154586808
Name:SOUTHERN PATHOLOGY SERVICES, INC.
Entity type:Organization
Organization Name:SOUTHERN PATHOLOGY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAQUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-841-8640
Mailing Address - Street 1:PO BOX 10729
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0729
Mailing Address - Country:US
Mailing Address - Phone:787-841-0042
Mailing Address - Fax:787-848-4043
Practice Address - Street 1:234-A PARQUE INDUSTRIAL SABANETA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-841-0042
Practice Address - Fax:787-848-4043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN PATHOLOGY SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-22
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1155291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory