NPIMap

Organization Active NPI

Southern Pathology Services, Inc.

Doing business as Laboratorio Clinico y Molecular Southern Pathology Services, Inc.

  • Clinical Medical Laboratory
  • Ponce, PR
National Provider Identifier
1154586808
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
1155 Issued in PR
Legal business name
SOUTHERN PATHOLOGY SERVICES, INC.
Doing business as
Laboratorio Clinico y Molecular Southern Pathology Services, Inc.
Practice address
234-A Parque Industrial Sabaneta
Ponce, PR 00716
Phone
(787) 841-0042
Fax
(787) 848-4043
NPI assigned
Jul 22, 2008
Last updated
May 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN PATHOLOGY SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Giovanna Vaquer
Title
Billing Supervisor
Phone
(787) 841-8640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 1155 PR Primary

Addresses

Primary practice location

234-A Parque Industrial Sabaneta
Ponce, PR 00716

Mailing address

PO Box 10729
Ponce, PR 00732-0729
Phone (787) 841-0042

Other names 1

  • Laboratorio Clinico y Molecular Southern Pathology Services, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141202001681 PR Part B Supplier - Independent Clinical Laboratory 7214259506 Practice locations: Ponce, PR

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Lab Patologico Dr Mendoza2 organizations share this tax ID, including this one
Part of
Lab Patologico Dr Mendoza

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589760000000",
    "number": "1154586808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10729",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "007320729",
            "telephone_number": "787-841-0042",
            "fax_number": "787-848-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234-A PARQUE INDUSTRIAL SABANETA",
            "city": "PONCE",
            "state": "PR",
            "postal_code": "00716",
            "telephone_number": "787-841-0042",
            "fax_number": "787-848-4043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PATHOLOGY SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN PATHOLOGY SERVICES INC",
        "enumeration_date": "2008-07-22",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A",
        "authorized_official_last_name": "VAQUER",
        "authorized_official_first_name": "GIOVANNA",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "787-841-8640",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PR",
            "license": "1155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laboratorio Clinico y Molecular Southern Pathology Services, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponce, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.