Provider Demographics
NPI:1427117472
Name:SURGICAL PATHOLOGY CONSULTANTS, INC.
Entity type:Organization
Organization Name:SURGICAL PATHOLOGY CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPAIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-547-1024
Mailing Address - Street 1:5422 W THUNDERBIRD RD
Mailing Address - Street 2:#13
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4700
Mailing Address - Country:US
Mailing Address - Phone:602-547-1024
Mailing Address - Fax:623-606-2458
Practice Address - Street 1:5422 W THUNDERBIRD RD
Practice Address - Street 2:#13
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4700
Practice Address - Country:US
Practice Address - Phone:602-547-1024
Practice Address - Fax:623-606-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10975246QH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ3D0877316OtherPTAN
AZE80443Medicare UPIN