Provider Demographics
NPI:1316997794
Name:PATHOLOGY CONSULTANTS INC.
Entity type:Organization
Organization Name:PATHOLOGY CONSULTANTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:EVANGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-458-5650
Mailing Address - Street 1:315 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-2910
Mailing Address - Country:US
Mailing Address - Phone:907-456-7767
Mailing Address - Fax:907-456-8050
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5925
Practice Address - Country:US
Practice Address - Phone:907-458-5650
Practice Address - Fax:907-456-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK29784291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK02D0641210OtherCLIA NUMBER
AK02D0641210OtherCLIA NUMBER