Provider Demographics
NPI:1194789867
Name:MIDWEST PATHOLOGY SPECIALISTS PLC
Entity type:Organization
Organization Name:MIDWEST PATHOLOGY SPECIALISTS PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-717-2875
Mailing Address - Street 1:PO BOX 4907
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104
Mailing Address - Country:US
Mailing Address - Phone:800-831-2402
Mailing Address - Fax:843-569-8503
Practice Address - Street 1:4955 F STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117
Practice Address - Country:US
Practice Address - Phone:402-717-2875
Practice Address - Fax:402-717-5231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CD8493OtherRR MEDICARE
IA44191OtherBCBS
IA0508986Medicaid
IA44191OtherBCBS
NE098754Medicare PIN