1205896594 NPI number — BOYCE - BYNUM PATHOLOGY LABORATORIES, INC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205896594 NPI number — BOYCE - BYNUM PATHOLOGY LABORATORIES, INC

Employer Identification Number (EIN):

Provider Organization Name:

BOYCE - BYNUM PATHOLOGY LABORATORIES, 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 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:

1205896594

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

06/20/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

200 PORTLAND ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

COLUMBIA

Provider Business Mailing Address State Name:

MO

Provider Business Mailing Address Postal Code:

65201-6525

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

573-886-4600

Provider Business Mailing Address Fax Number:

573-886-4695

Provider First Line Business Practice Location Address:

200 PORTLAND ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

COLUMBIA

Provider Business Practice Location Address State Name:

MO

Provider Business Practice Location Address Postal Code:

65201

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

573-886-4600

Provider Business Practice Location Address Fax Number:

573-886-4695

Provider Enumeration Date:

03/23/2006

Authorized Official Last Name:

COTTEN

Authorized Official First Name:

RICHARD

Authorized Official Middle Name:

E

Authorized Official Title or Position:

CHIEF OPERATING OFFICER

Authorized Official Telephone Number:

573-886-4600

• Taxonomy code: 291U00000X , with the licence number:  26D0652373 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 120064 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 126758709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 100455390B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 700595812 . This is a "MISSOURI CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 700595812 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 275331 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 6593789800 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 36079966 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
• Identifier: 20030120A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: 2194119 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
• Identifier: 300000488 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 8156825 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
• Identifier: 888497 . This is a "MERCY CAREPLUS" identifier . This identifiers is of the category "OTHER".