1366466856 NPI number — CLINICAL PATHOLOGY ASSOCIATES, LLC

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 1366466856 NPI number — CLINICAL PATHOLOGY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL PATHOLOGY ASSOCIATES, LLC
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:
1366466856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 SUNNYVIEW LN
Provider Second Line Business Mailing Address:
DEPARTMENT OF PATHOLOGY
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-752-1789
Provider Business Mailing Address Fax Number:
406-751-5776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 SUNNYVIEW LN
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PATHOLOGY
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-3129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-752-1789
Provider Business Practice Location Address Fax Number:
406-751-5776
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
PETER
Authorized Official Middle Name:
ANTHONY FISHER
Authorized Official Title or Position:
PATHOLOGIST
Authorized Official Telephone Number:
406-752-1789

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  9546 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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