Provider Demographics
NPI:1346307774
Name:PATHOLOGY & IMAGING CONSULTANTS, PC
Entity Type:Organization
Organization Name:PATHOLOGY & IMAGING CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:701-857-5436
Mailing Address - Street 1:1410 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3658
Mailing Address - Country:US
Mailing Address - Phone:701-857-5436
Mailing Address - Fax:
Practice Address - Street 1:1410 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3658
Practice Address - Country:US
Practice Address - Phone:701-857-5436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3135291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14414Medicaid
NDD26303Medicare UPIN
ND14414Medicaid