Provider Demographics
NPI:1962702225
Name:JOPLIN PATHOLOGY PROFESSIONALS PC
Entity type:Organization
Organization Name:JOPLIN PATHOLOGY PROFESSIONALS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HURLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-623-6330
Mailing Address - Street 1:2700 MCCLELLAND BLVD
Mailing Address - Street 2:205B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1623
Mailing Address - Country:US
Mailing Address - Phone:417-623-6330
Mailing Address - Fax:471-623-3950
Practice Address - Street 1:2727 MCCLELLAND BLVD
Practice Address - Street 2:ST. JOHN'S REGIONAL MED CTR PATHOLOGY DEPT
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1626
Practice Address - Country:US
Practice Address - Phone:417-625-2130
Practice Address - Fax:417-625-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1962702225Medicaid
KS200689110AMedicaid
OK200317740AMedicaid
MA2995Medicare PIN