Provider Demographics
NPI:1386743169
Name:ANAPATH DIAGNOSTICS, INC
Entity type:Organization
Organization Name:ANAPATH DIAGNOSTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:CCS
Authorized Official - Phone:307-634-9238
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-0205
Mailing Address - Country:US
Mailing Address - Phone:307-634-9238
Mailing Address - Fax:307-778-3665
Practice Address - Street 1:2301 HOUSE AVE STE 108
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3177
Practice Address - Country:US
Practice Address - Phone:307-634-9238
Practice Address - Fax:307-778-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-00Medicaid
WYW306535Medicare ID - Type UnspecifiedMEDICARE PART B