Provider Demographics
NPI:1174638985
Name:PATHLAB LLC
Entity Type:Organization
Organization Name:PATHLAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-225-2522
Mailing Address - Street 1:PO BOX 1453
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-1453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 1ST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4437
Practice Address - Country:US
Practice Address - Phone:620-225-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty