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Organization
PARKWAY PATHOLOGY GROUP
Active
Organization
PARKWAY PATHOLOGY GROUP
Active
Parent organization
PARKWAY PATHOLOGY GROUP
Other names
Parkway Pathology MO Bap Sullivan
Organization subpart
Yes
Provider details
NPI number
Legal business name
PARKWAY PATHOLOGY GROUP
Authorized official
CHARLES SHORT MD (PRESIDENT)
(314) 996-4285
Entity
Organization
Contact information
Practice address
751 SAPPINGTON BRIDGE RD, ATTN: PATHOLOGY DEPARTMENT, SULLIVAN, MO 63080-2354
(573) 468-4186
Mailing address
PO BOX 500720, SAINT LOUIS, MO 63150-0720
(314) 989-0300
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
NULL
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
NULL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
07/12/2007
Last updated
10/22/2007
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