Provider Demographics
NPI:1003069493
Name:SUMMIT PATHOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:SUMMIT PATHOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-375-3786
Mailing Address - Street 1:30701 LORAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-6325
Mailing Address - Country:US
Mailing Address - Phone:440-274-5035
Mailing Address - Fax:440-716-8608
Practice Address - Street 1:155 5TH ST NE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3332
Practice Address - Country:US
Practice Address - Phone:330-615-3966
Practice Address - Fax:330-615-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
026437100OtherFEDERAL BLACK LUNG
OH2882680Medicaid
127732600OtherUNITED DEPARTMENT OF LABOR
8463565OtherAETNA
8463565OtherAETNA
OH2882680Medicaid