Provider Demographics
NPI:1134119233
Name:SOUTHERN PATHOLOGY SERVICES, INC.
Entity type:Organization
Organization Name:SOUTHERN PATHOLOGY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAQUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-841-8645
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:787-843-3464
Practice Address - Street 1:234 DAIGUE INDUSTRIAL SABANETIS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00715
Practice Address - Country:US
Practice Address - Phone:787-841-8640
Practice Address - Fax:787-043-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D26718Medicare UPIN
PR98540Medicare ID - Type Unspecified