Provider Demographics
NPI:1346429156
Name:KIRKWOOD PATHOLOGY SERVICES INC
Entity Type:Organization
Organization Name:KIRKWOOD PATHOLOGY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-966-1500
Mailing Address - Street 1:PO BOX 439
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63022-0439
Mailing Address - Country:US
Mailing Address - Phone:800-354-1088
Mailing Address - Fax:314-631-4491
Practice Address - Street 1:525 COUCH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-5536
Practice Address - Country:US
Practice Address - Phone:314-966-1500
Practice Address - Fax:314-631-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1208OtherBCBS