1992818900 NPI number — WILLIAMSPORT PATHOLOGY ASSOCS.

Table of content: (NPI 1992818900)

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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