1316997794 NPI number — PATHOLOGY CONSULTANTS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316997794 NPI number — PATHOLOGY CONSULTANTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHOLOGY CONSULTANTS 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:
1316997794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 ILLINOIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99701-2910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-456-7767
Provider Business Mailing Address Fax Number:
907-456-8050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 COWLES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-5925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-458-5650
Provider Business Practice Location Address Fax Number:
907-456-8050
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVANGER
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-458-5650

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  29784 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02D0641210 . This is a "CLIA NUMBER" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".




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