Provider Demographics
NPI:1114994290
Name:WESTERN PATHOLOGY SERVICES PA
Entity Type:Organization
Organization Name:WESTERN PATHOLOGY SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:VACHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-272-2263
Mailing Address - Street 1:PO BOX 1876
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1876
Mailing Address - Country:US
Mailing Address - Phone:316-685-8428
Mailing Address - Fax:316-652-0340
Practice Address - Street 1:1610 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-4746
Practice Address - Country:US
Practice Address - Phone:800-475-6236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100212970AMedicaid
KS014133OtherBCBS
CU0440OtherRAILROAD MEDICARE
OK10722730AMedicaid
CU0440OtherRAILROAD MEDICARE