Provider Demographics
NPI:1306919527
Name:CYTOLOGY PATHOLOGY SERVICES INC.
Entity type:Organization
Organization Name:CYTOLOGY PATHOLOGY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PIETER
Authorized Official - Middle Name:
Authorized Official - Last Name:WIERSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-255-3579
Mailing Address - Street 1:5865 MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-1740
Mailing Address - Country:US
Mailing Address - Phone:317-255-3579
Mailing Address - Fax:317-255-3530
Practice Address - Street 1:5865 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-1740
Practice Address - Country:US
Practice Address - Phone:317-255-3579
Practice Address - Fax:317-255-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50002033A291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100284860AMedicaid
INX11398Medicare UPIN
IN100284860AMedicaid