Provider Demographics
NPI:1972651818
Name:PATHOLOGYSERVICES.ORG LLC
Entity type:Organization
Organization Name:PATHOLOGYSERVICES.ORG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CYTOTECHNOLOGIST PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CT,IAC,ASCP
Authorized Official - Phone:231-590-5030
Mailing Address - Street 1:DEPT 77225 PATHOLOGY SERVICES ORG LLC
Mailing Address - Street 2:PO BOX 77000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-0225
Mailing Address - Country:US
Mailing Address - Phone:231-590-5030
Mailing Address - Fax:231-889-5969
Practice Address - Street 1:1465 E PARKDALE AVE
Practice Address - Street 2:PATHOLOGY SERVICES.ORG LLC ATTN LISA WORLEY
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660
Practice Address - Country:US
Practice Address - Phone:231-590-5030
Practice Address - Fax:231-889-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051173 MD246Q00000X, 246QH0600X, 246RM2200X
MI4301051173246QB0000X
CACLM089246QC2700X
MI246QC2700X, 246QH0600X, 246QL0900X, 246R00000X, 246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Single Specialty
No246QB0000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyBlood BankingGroup - Single Specialty
No246QC2700XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyCytotechnologyGroup - Single Specialty
No246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistologyGroup - Single Specialty
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory ManagementGroup - Single Specialty
No246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI303702OtherTENCON
MI71020000E1 1500OtherBCBS OF MICH FEDERAL
MI162381523463OtherHUMMANA
MI=========OtherCOMMUNITY CHOICE
MI=========-A01OtherMEDICAL MUTUAL
MI71020000E1 1500OtherBCBS OF MICH FEDERAL
MI=========OtherPRIORITY HEALTH
MI=========OtherMOLINA HEALTHCARE OF MICH
MI0N4330Medicare ID - Type Unspecified