Provider Demographics
NPI:1316013956
Name:PATHOLOGY ASSOCIATES OF STURDY MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF STURDY MEMORIAL HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD MBA
Authorized Official - Phone:508-222-5200
Mailing Address - Street 1:291 MOODY STREET
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-1246
Mailing Address - Country:US
Mailing Address - Phone:800-688-6663
Mailing Address - Fax:413-589-0761
Practice Address - Street 1:211 PARK STREET
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3143
Practice Address - Country:US
Practice Address - Phone:508-222-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA643382OtherHARVARD PILGRIM HEALTHCAR
CN4749OtherRAILROAD MEDICARE
103138100OtherUS DEPARTMENT OF LABOR
MAM16808OtherBCBS OF MASS
MA50039OtherFALLON COMMUNITY HEALTH P
MA988026OtherNETWORK HEALTH
MA0013864OtherNEIGHBORHOOD HEALTH PLAN
MA616323OtherTUFTS
MA9782001Medicaid
CN4749OtherRAILROAD MEDICARE