Provider Demographics
NPI:1124126024
Name:PLEASANT VALLEY PATHOLOGY ASSOCIATES
Entity type:Organization
Organization Name:PLEASANT VALLEY PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SCHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-675-4340
Mailing Address - Street 1:2520 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-2031
Mailing Address - Country:US
Mailing Address - Phone:304-675-4340
Mailing Address - Fax:304-675-1328
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2031
Practice Address - Country:US
Practice Address - Phone:304-675-4340
Practice Address - Fax:304-675-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15018207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0672311Medicaid
WV0008613000Medicaid
WV=========OtherAETNA
WV9278941Medicare ID - Type UnspecifiedMEDICARE