1801935879 NPI number — PATHOLOGY SERVICES OF SPRINGFIELD, P.C.

Table of content: (NPI 1801935879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801935879 NPI number — PATHOLOGY SERVICES OF SPRINGFIELD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATHOLOGY SERVICES OF SPRINGFIELD, P.C.
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:
1801935879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E PRIMROSE ST STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65807-5180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-269-4646
Provider Business Mailing Address Fax Number:
417-269-8078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E PRIMROSE ST STE 550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65807-5180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-269-4646
Provider Business Practice Location Address Fax Number:
417-269-8078
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SKRADE
Authorized Official First Name:
JAMI
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
417-269-4646

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  26D0652448 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1559 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 700100407 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com