Provider Demographics
NPI:1306032891
Name:SOUTHWESTERN PATHOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWESTERN PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATHOLOGY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-536-0021
Mailing Address - Street 1:4704 NW MOTIF MANOR BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4800
Mailing Address - Country:US
Mailing Address - Phone:580-536-0021
Mailing Address - Fax:580-536-1024
Practice Address - Street 1:4704 NW MOTIF MANOR BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-4800
Practice Address - Country:US
Practice Address - Phone:580-536-0021
Practice Address - Fax:580-536-1024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN PATHOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19385174400000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5001537OtherGHI
NY2738769Medicaid
DD1085OtherRR MEDICARE
NJ2359692000OtherAMERIHEALTH
NJ0051543Medicaid
NJ2359692000OtherAMERIHEALTH
OKG20266Medicare UPIN
OK=========Medicare PIN
NJ5001537OtherGHI