Provider Demographics
NPI:1386973501
Name:PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-755-8903
Mailing Address - Street 1:PO BOX 2720
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-4002
Mailing Address - Country:US
Mailing Address - Phone:509-755-8600
Mailing Address - Fax:
Practice Address - Street 1:2819 GREAT NORTHERN LOOP
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1750
Practice Address - Country:US
Practice Address - Phone:406-549-3967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHOLOGY ASSOCIATES MEDICAL LABORATORIES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory