1609859560 NPI number — COMPREHENSIVE PATHOLOGY SERVICES LC

Table of content: (NPI 1609859560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609859560 NPI number — COMPREHENSIVE PATHOLOGY SERVICES LC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PATHOLOGY SERVICES LC
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:
1609859560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 842049
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CIY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64184-2049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-821-8055
Provider Business Mailing Address Fax Number:
314-821-1833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 BOWLES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63026-2394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-496-2720
Provider Business Practice Location Address Fax Number:
314-821-1833
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAW
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
314-768-8202

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  26D0045374 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 26D0437653 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 208837211 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI2882 . This is a "TRAVELERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7556 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9801344 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042938 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 29381 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 373987 . This is a "HEALTH LINK" identifier . This identifiers is of the category "OTHER".




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