1780924233 NPI number — WESTERN PATHOLOGY INC

Table of content: (NPI 1780924233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780924233 NPI number — WESTERN PATHOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN PATHOLOGY 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:
1780924233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-5692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-548-1550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3440 EMPRESA DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SAN LUIS OBISPO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93401-7345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-543-5000
Provider Business Practice Location Address Fax Number:
805-543-5199
Provider Enumeration Date:
02/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LUNDQUIST
Authorized Official First Name:
KURT
Authorized Official Middle Name:
F
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/PRESIDENT
Authorized Official Telephone Number:
805-748-6214

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)





Copyright © 2007-2025 www.npivalidator.com