1407810518 NPI number — AFFILIATED PATHOLOGISTS PA

Table of content: KATHERINE REBEKKAH STIMSON LMT (NPI 1477188787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407810518 NPI number — AFFILIATED PATHOLOGISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFILIATED PATHOLOGISTS PA
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:
1407810518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1867
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76202-1867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-384-6270
Provider Business Mailing Address Fax Number:
940-382-7680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 E PECAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTUS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73521-6141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-384-6270
Provider Business Practice Location Address Fax Number:
940-382-7680
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
940-384-6270

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: 100751010A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121710101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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