1265465801 NPI number — LOUISVILLE PATHOLOGY ASSOCIATES PSC

Table of content: (NPI 1265465801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265465801 NPI number — LOUISVILLE PATHOLOGY ASSOCIATES PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISVILLE PATHOLOGY ASSOCIATES 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:
1265465801
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 SOUTHWYCK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43614-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-288-8325
Provider Business Mailing Address Fax Number:
419-866-5453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 ABRAHAM FLEXNER WAY
Provider Second Line Business Practice Location Address:
PATHOLOGY DEPT
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-456-6212
Provider Business Practice Location Address Fax Number:
502-456-4440
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TISONE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
LABORATORY MEDICAL DIRECTOR
Authorized Official Telephone Number:
502-456-6212

Provider Taxonomy Codes

  • Taxonomy code: 207ZB0001X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZC0500X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZH0000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100237730 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0781049-01 . This is a "MEDICAID TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 206644601 . This is a "MEDICAID MISSOURI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 290445 . This is a "BLACK LUNG PROGRAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912684800 . This is a "MEDICAID FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CF7906 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0956501 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100009590A . This is a "MEDICAID INDIANA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1050655 . This is a "PASSPORT MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1301279 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4281366 . This is a "MEDICAID TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9114175 . This is a "MEDICAID COLORADO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 144621 . This is a "WORKERS COMP NEVADA" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 163417200 . This is a "WORKERS COMP FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6602886 . This is a "MEDICAID VIRGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000058947 . This is a "ANTHEM BLUE CROSS BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1100338 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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