Provider Demographics
NPI:1992787030
Name:PUGET SOUND INSTITUTE OF PATHOLOGY PLLC
Entity type:Organization
Organization Name:PUGET SOUND INSTITUTE OF PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-622-7747
Mailing Address - Street 1:PO BOX 34245
Mailing Address - Street 2:PSIP PLLC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1245
Mailing Address - Country:US
Mailing Address - Phone:206-622-7747
Mailing Address - Fax:206-467-1470
Practice Address - Street 1:1001 KLICKITAT WAY SW #205
Practice Address - Street 2:PUGET SOUND INSTITUTE OF PATHOLOGY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134
Practice Address - Country:US
Practice Address - Phone:206-622-7747
Practice Address - Fax:206-467-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACLIA 5000633091207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA161839OtherDEPT OF LABOR INDUSTRIES
WA81407OtherDEPT OF LABOR INDUSTRIES
WA7066947Medicaid
WAG000165200Medicare PIN