1841281664 NPI number — CONSULTANTS IN PATHOLOGY, INC.

Table of content: (NPI 1841281664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841281664 NPI number — CONSULTANTS IN PATHOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTANTS IN PATHOLOGY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841281664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKESBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28697-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-838-9550
Provider Business Mailing Address Fax Number:
336-838-9536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N BRIDGE ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28697-2488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-838-9550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RANDALL
Authorized Official First Name:
WENDELL
Authorized Official Middle Name:
LEWIS
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
336-838-9550

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0500X , with the licence number:  36016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0101X , with the licence number: 36016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 36016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01953 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8901953 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".