Provider Demographics
NPI:1396751947
Name:WYOMING PATHOLOGY INC
Entity type:Organization
Organization Name:WYOMING PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARTINCHICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-742-2141
Mailing Address - Street 1:PO BOX 270592
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-5009
Mailing Address - Country:US
Mailing Address - Phone:405-947-8584
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:255 N 30TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-5140
Practice Address - Country:US
Practice Address - Phone:307-742-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY611967200OtherDOL BLACK LUNG
WY86079OtherALTIUS HEALTHCARE
WY106246800Medicaid
CO1695Medicare PIN
WYW4371740Medicare PIN