Provider Demographics
NPI:1992769525
Name:NEWBERRY PATHOLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:NEWBERRY PATHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FINANCIAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-223-3070
Mailing Address - Street 1:PO BOX 49009
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-0001
Mailing Address - Country:US
Mailing Address - Phone:864-223-3070
Mailing Address - Fax:864-223-1396
Practice Address - Street 1:2669 KINARD ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2911
Practice Address - Country:US
Practice Address - Phone:888-446-9898
Practice Address - Fax:803-276-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5559207ZF0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1437Medicaid
42D0248801OtherCLIA REGISTRATION#
CG8639OtherRAILROAD MEDICARE
SCGP1437Medicaid
SC5150Medicare PIN