Provider Demographics
NPI:1144383423
Name:ARIZONA PATHOLOGY GROUP INC.
Entity type:Organization
Organization Name:ARIZONA PATHOLOGY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP SECRETARY TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DILLEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-712-6200
Mailing Address - Street 1:7111 FAIRWAY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-4204
Mailing Address - Country:US
Mailing Address - Phone:561-712-6265
Mailing Address - Fax:561-712-7349
Practice Address - Street 1:2755 SILVER CREEK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7904
Practice Address - Country:US
Practice Address - Phone:928-763-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory