1841281664 NPI number — CONSULTANTS IN PATHOLOGY, 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 1841281664 NPI number — CONSULTANTS IN PATHOLOGY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTANTS IN PATHOLOGY, 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:
1841281664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKESBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28697-1239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-838-9550
Provider Business Mailing Address Fax Number:
336-838-9536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N BRIDGE ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKESBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28697-2488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-838-9550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RANDALL
Authorized Official First Name:
WENDELL
Authorized Official Middle Name:
LEWIS
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
336-838-9550

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0500X , with the licence number:  36016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0101X , with the licence number: 36016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 36016 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01953 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8901953 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".