1013131572 NPI number — HENDERSON PATHOLOGY & CYTOPATHOLOGY SERVICES PSC

Table of content: (NPI 1013131572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013131572 NPI number — HENDERSON PATHOLOGY & CYTOPATHOLOGY SERVICES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENDERSON PATHOLOGY & CYTOPATHOLOGY SERVICES PSC
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:
1013131572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 934
Provider Second Line Business Mailing Address:
1228 N ELM ST
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-827-5399
Provider Business Mailing Address Fax Number:
270-827-5327

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-827-9701
Provider Business Practice Location Address Fax Number:
270-883-1781
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORPUS
Authorized Official First Name:
P
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR PATHOLOGY SERVICES
Authorized Official Telephone Number:
270-827-9701

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65905382 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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