Provider Demographics
NPI:1144624073
Name:BOSTWICK PATHOLOGY
Entity type:Organization
Organization Name:BOSTWICK PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSTWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-927-7764
Mailing Address - Street 1:408 BAY CV
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-9203
Mailing Address - Country:US
Mailing Address - Phone:601-927-7764
Mailing Address - Fax:
Practice Address - Street 1:408 BAY CV
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-9203
Practice Address - Country:US
Practice Address - Phone:601-927-7764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04959291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSN/AOtherBLUE CROSS