1407099732 NPI number — LAKEWOOD PATHOLOGY ASSOCIATES, INC.

Table of content: (NPI 1407099732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407099732 NPI number — LAKEWOOD PATHOLOGY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEWOOD PATHOLOGY ASSOCIATES, 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:
INFORM DIAGNOSTICS
Provider Other Organization Name Type Code:
3
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:
1407099732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6655 N MACARTHUR BLVD
Provider Second Line Business Mailing Address:
ATTN: PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75039-2443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-596-7031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5470 BLUE RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORBA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-440-7284
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SIMONDS
Authorized Official First Name:
DANA
Authorized Official Middle Name:
ARLENE
Authorized Official Title or Position:
SVP, COMPLIANCE, ETHICS & QUALITY
Authorized Official Telephone Number:
214-277-8700

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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