MATTISON PATHOLOGY, LLP (NPI# 1104308915) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104308915 |
| Entity Type | Organization |
| Organization Name | MATTISON PATHOLOGY, LLP |
| Other Organization Name | AVERO DIAGNOSTICS |
| Practice Address |
5230 S State Rd Ann Arbor MI 48108-7936 |
| Mailing Address |
5230 S State Rd Attn Credentialing Dept Ann Arbor MI 48108-7936 |
| Practice Telephone | 8552932639 |
| Practice Fax Number | 7345488666 |
| Mailing Telephone | 7347940688 |
| Mailing Fax Number | 7345488666 |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | DR. MICHAEL TRAE MATTISON (OWNER) |
| Authorized Official Telephone | 8067761098 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | MATTISON PATHOLOGY, LLP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
23D2151839 | MI | Allopathic & Osteopathic Physicians |
| Y | 291U00000X | Clinical Medical Laboratory | 23D2151839 | MI | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | CLIA | 23D2151839 | 01 |
| Other Name | Type Code |
|---|---|
| Avero Diagnostics | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093820763 | Mattison Pathology, LLP | Clinical Medical Laboratory | 410 N Utica Ave, Lubbock, TX 79416-3035 | 2006-08-20 |
| Street Address |
5230 S STATE RD |
| City | ANN ARBOR |
| State | MI |
| Zip Code | 48108-7936 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700102142 | James Zdrodowski | Genetic Counselor, MS | 5230 S State Rd, Ann Arbor, MI 48108-7936 | 2010-04-09 |
| 1467948422 | Craig Ryan Adamski | Genetic Counselor, MS | 5230 S State Rd, Ann Arbor, MI 48108-7936 | 2018-07-02 |
| 1356855423 | Jennifer Catherine Luque | Genetic Counselor, MS | 5230 S State Rd, Ann Arbor, MI 48108-7936 | 2017-11-27 |
| 1114222817 | Progenity Inc. | Clinical Medical Laboratory | 5230 S State Rd, Ann Arbor, MI 48108-7936 | 2011-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750999249 | Creating Brighter Futures | Behavioral Analyst | 4201 Varsity Drive, Ste. C, Ann Arbor, MI 48108 | 2020-07-21 |
| 1326506320 | Michelle Bishop | Behavior Technician | 4935 Birch Hollow Dr, Ann Arbor, MI 48108 | 2019-03-08 |
| 1407326077 | Alexis Ewald | Behavior Technician | 2770 Carpenter Rd., Ann Arbor, MI 48108 | 2018-11-27 |
| 1003308511 | Ann Arbor Dental Specialists | Dentist | 3100 Eisenhower Parkway, Suite 200, Ann Arbor, MI 48108 | 2018-05-31 |
| 1144719295 | Jonathan Parker Etter | Physical Medicine & Rehabilitation | 325 E. Eisenhower, Suite 300, Spc 5744, Ann Arbor, MI 48108 | 2018-05-04 |
| 1427555895 | Blossom Health Services LLC | Social Worker | 2156 Glencoe Hills Dr Apt 12, Ann Arbor, MI 48108 | 2018-04-11 |
| 1669974580 | Camron Anthony Moorehead | Occupational Therapist | 400 E. Eisenhower Parkway Bldg 2, Ste A, Ann Arbor, MI 48108 | 2018-03-07 |
| 1396247862 | Crystal Ann D'agostino | Health Educator | 1169 Oak Valley Drive, Ann Arbor, MI 48108 | 2018-03-01 |
| 1538671250 | Miea Moon | Psychologist | 3200 E Eisenhower Parkway, Moriah Hall, Ann Arbor, MI 48108 | 2017-11-03 |
| 1003355546 | Rachael Connolly | Behavior Technician | 4201 Varsity Drive Suite C, Ann Arbor, MI 48108 | 2017-02-16 |
| Find all providers in zip 48108 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
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|---|---|---|---|---|
| 1467073460 | Lynx Dx Inc | Clinical Medical Laboratory | 333 Jackson Plz Ste 600, Ann Arbor, MI 48103-1922 | 2020-04-30 |
| 1790320380 | Strata Oncology, Inc. | Clinical Medical Laboratory | 8170 Jackson Rd Ste A, Ann Arbor, MI 48103-9100 | 2019-11-07 |
| 1750668703 | Everist Genomics, Inc. | Clinical Medical Laboratory | 709 W Ellsworth Rd, Ann Arbor, MI 48108-3371 | 2011-11-04 |
| 1568767929 | Everist Genomics | Clinical Medical Laboratory | 401 W Morgan Rd, Ann Arbor, MI 48108-9109 | 2011-01-17 |
| 1972755676 | Organ Procurement Agency of Michigan | Clinical Medical Laboratory | 3861 Research Park Dr, Ann Arbor, MI 48108-2217 | 2008-10-14 |
| 1083635163 | Frances Warde Medical Laboratory | Clinical Medical Laboratory | 300 W Textile Rd, Ann Arbor, MI 48108-9548 | 2006-07-22 |
| 1740676717 | Armune Bioscience Inc | Clinical Medical Laboratory | 401 W Morgan Rd, Ann Arbor, MI 48108-9109 | 2015-04-07 |
| 1548502255 | Millennium Health, LLC | Clinical Medical Laboratory | 401 W Morgan Rd, Ann Arbor, MI 48108-9109 | 2013-03-20 |
| 1114222817 | Progenity Inc. | Clinical Medical Laboratory | 5230 S State Rd, Ann Arbor, MI 48108-7936 | 2011-01-11 |
| 1538474952 | Convinza Medical Solutions LLC | Clinical Medical Laboratory | 300 W Textile Rd, Ann Arbor, MI 48108-9548 | 2010-08-10 |
| Find all providers in ANN ARBOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.