Provider Demographics
NPI:1326077421
Name:DRS NEDELKOFF, PAST AND JONES
Entity Type:Organization
Organization Name:DRS NEDELKOFF, PAST AND JONES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-948-7408
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47151-1286
Mailing Address - Country:US
Mailing Address - Phone:502-458-8653
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:812-948-7408
Practice Address - Fax:812-949-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
280028OtherBLACK LUNG PROGRAM
KY1056637OtherPASSPORT MEDICAID
1300781OtherUNITED MINE WORKERS
CB2272OtherRAILROAD MEDICARE
KY7100239320Medicaid
FL129043700OtherWORKERS COMP FLORIDA
IN100116000AMedicaid
1100194OtherUNITED HEALTHCARE
IN=========001OtherANTHEM BLUE CROSS BS
CB2272OtherRAILROAD MEDICARE
IN100116000AMedicaid