Organization
PATH LAB DIAGNOSTIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NESTOR PAMATMAT M.D. (PRESIDENT)
(877) 861-9294
Entity
Organization
Contact information
Practice address
3333 N SEMINARY ST, GALESBURG, IL 61401-1251
(877) 861-9294
Mailing address
PO BOX 9518, PEORIA, IL 61612-9518
(877) 861-9294
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04832025
BLUE CROSS BLUE SHIELD
IL
01
—
DE5890
RAILROAD MEDICARE
IL
Enumeration date
06/28/2006
Last updated
05/12/2011
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