1902885361 NPI number — SOUTHWESTERN PATHOLOGISTS, INC.

Table of content: SEAMUS M SIDDALL PA-C (NPI 1376782458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902885361 NPI number — SOUTHWESTERN PATHOLOGISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWESTERN PATHOLOGISTS, 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:
1902885361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 DELLWOOD AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45419-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-554-2695
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1141 N MONROE DR
Provider Second Line Business Practice Location Address:
GREENE MEMORIAL HOSPITAL PATH DEPT
Provider Business Practice Location Address City Name:
XENIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45385-1619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-372-8011
Provider Business Practice Location Address Fax Number:
937-352-3162
Provider Enumeration Date:
01/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-352-2165

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0721508 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB1381 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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