Provider Demographics
NPI:1306585377
Name:CAPITOL PATHOLOGY SPECIALISTS GROUP
Entity type:Organization
Organization Name:CAPITOL PATHOLOGY SPECIALISTS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANATOMIC PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-744-5124
Mailing Address - Street 1:2203 TWIN OAKS DR APT 67
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-2972
Mailing Address - Country:US
Mailing Address - Phone:202-744-5124
Mailing Address - Fax:
Practice Address - Street 1:2800 E ROCK HAVEN RD
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-4411
Practice Address - Country:US
Practice Address - Phone:816-380-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-30
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100642360AMedicaid
MO010326106Medicaid
WI11022900Medicaid