1952442402 NPI number — PIMA PATHOLOGISTS, PC

Table of content: (NPI 1952442402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952442402 NPI number — PIMA PATHOLOGISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIMA PATHOLOGISTS, PC
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:
1952442402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2288
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67201-2288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-884-0921
Provider Business Mailing Address Fax Number:
520-884-7670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 W ST MARY'S ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-872-6032
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STROHM
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
520-884-0921

Provider Taxonomy Codes

  • Taxonomy code: 207U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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