Provider Demographics
NPI:1861535718
Name:PATHOLOGY ASSOCIATES OF ANAHEIM A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF ANAHEIM A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-719-2148
Mailing Address - Street 1:1111 W LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2804
Mailing Address - Country:US
Mailing Address - Phone:714-999-6075
Mailing Address - Fax:714-999-3822
Practice Address - Street 1:1111 W LA PALMA AVE
Practice Address - Street 2:AMMC - DEPT. OF PATHOLOGY
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2804
Practice Address - Country:US
Practice Address - Phone:714-999-6075
Practice Address - Fax:714-999-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50440207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ69658ZOtherBLUE SHIELD
CAGR0104860Medicaid
CAGR0104860Medicaid