1992818900 NPI number — WILLIAMSPORT PATHOLOGY ASSOCS.

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 1992818900 NPI number — WILLIAMSPORT PATHOLOGY ASSOCS.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMSPORT PATHOLOGY ASSOCS.
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:
1992818900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 SOUTHWYCK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43614-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-288-8325
Provider Business Mailing Address Fax Number:
419-866-4553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 RURAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-321-2321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DILLMAN
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
800-288-8325

Provider Taxonomy Codes

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

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

  • Identifier: 0009692280005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC4291 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 400563 . This is a "HIGHMARK/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0009692280003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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