Provider Demographics
NPI:1154393858
Name:PATHOLOGY ASSOCIATES
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-589-8614
Mailing Address - Street 1:250 MERCY DR
Mailing Address - Street 2:P O BOX 731
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52004-0731
Mailing Address - Country:US
Mailing Address - Phone:563-556-2012
Mailing Address - Fax:563-556-0986
Practice Address - Street 1:250 MERCY DR
Practice Address - Street 2:ROOM G211
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52004-0731
Practice Address - Country:US
Practice Address - Phone:563-556-2012
Practice Address - Fax:563-556-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32695400Medicaid
IA0161232Medicaid
IA16123OtherBCBS IOWA PROVIDER GROUP
IACO1425OtherRAILROAD MEDICARE
IA16123Medicare PIN