Provider Demographics
NPI:1265465801
Name:LOUISVILLE PATHOLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:LOUISVILLE PATHOLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:TISONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-456-6212
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1818
Practice Address - Country:US
Practice Address - Phone:502-456-6212
Practice Address - Fax:502-456-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207ZB0001X, 207ZC0500X, 207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100237730Medicaid
TX0781049-01OtherMEDICAID TEXAS
MO206644601OtherMEDICAID MISSOURI
290445OtherBLACK LUNG PROGRAM
FL912684800OtherMEDICAID FLORIDA
CF7906OtherRAILROAD MEDICARE
0956501OtherCIGNA HEALTHCARE
IN100009590AOtherMEDICAID INDIANA
KY1050655OtherPASSPORT MEDICAID
1301279OtherUNITED MINE WORKERS
TN4281366OtherMEDICAID TENNESSEE
CO9114175OtherMEDICAID COLORADO
NV144621OtherWORKERS COMP NEVADA
FL163417200OtherWORKERS COMP FLORIDA
VA6602886OtherMEDICAID VIRGINIA
KY000000058947OtherANTHEM BLUE CROSS BS
1100338OtherUNITED HEALTHCARE
TN4281366OtherMEDICAID TENNESSEE
IN100009590AOtherMEDICAID INDIANA