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Organization
MONUMENT PATHOLOGISTS INC
Active
Organization
MONUMENT PATHOLOGISTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK WILSON MD (DIRECTOR)
(630) 472-8800
Entity
Organization
Contact information
Practice address
5801 BREMO RD, RICHMOND, VA 23226-1907
(804) 764-6881
Mailing address
PO BOX 91726, RICHMOND, VA 23291-1726
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004282
ANTHEM-BREMO ROAD
VA
01
—
182967
ANTHEM BCBS - ST. FRANCIS
VA
01
—
217815
ANTHEM-ATLEE ROAD
VA
01
—
52662
SOUTHERN HEALTH
—
01
—
570207
OPTIMAHEALTH
—
01
—
CI4193
RAILROAD MEDICARE
—
Enumeration date
08/19/2005
Last updated
04/02/2025
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