Provider Demographics
NPI:1386916724
Name:NORTH PLATTE PATHOLOGY LLC
Entity type:Organization
Organization Name:NORTH PLATTE PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-337-1670
Mailing Address - Street 1:PO BOX 2090
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82602-2090
Mailing Address - Country:US
Mailing Address - Phone:307-337-1670
Mailing Address - Fax:
Practice Address - Street 1:111 S JEFFERSON ST
Practice Address - Street 2:STE 150B
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2654
Practice Address - Country:US
Practice Address - Phone:307-337-1670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory