Provider Demographics
NPI:1003859711
Name:PATHOLOGY GROUP PC
Entity Type:Organization
Organization Name:PATHOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-947-8584
Mailing Address - Street 1:PO BOX 26303
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0303
Mailing Address - Country:US
Mailing Address - Phone:405-947-8584
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:1000 N LEE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1036
Practice Address - Country:US
Practice Address - Phone:405-272-7041
Practice Address - Fax:405-948-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3090902OtherBCBS TN
OK=========001OtherBCBS OF OK
TN3090902OtherBCBS TN
OK=========001OtherTRICARE MEMORIAL LOCATION
CN3419Medicare PIN
OK=========Medicare PIN