Organization
GALESBURG PATHOLOGY GROUP, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD F SANTOS M.D. (PRESIDENT)
(309) 343-5899
Entity
Organization
Contact information
Practice address
695 N KELLOGG ST, GALESBURG, IL 61401-2807
(309) 345-4562
Mailing address
PO BOX 10140, PEORIA, IL 61612-0140
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04815048
BCBS
IL
01
—
CM6787
RAILROAD MEDICARE
IL
Enumeration date
05/22/2006
Last updated
07/12/2007
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