Provider Demographics
NPI:1366466856
Name:CLINICAL PATHOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CLINICAL PATHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANTHONY FISHER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-752-1789
Mailing Address - Street 1:310 SUNNYVIEW LN
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3129
Mailing Address - Country:US
Mailing Address - Phone:406-752-1789
Mailing Address - Fax:406-751-5776
Practice Address - Street 1:310 SUNNYVIEW LN
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3129
Practice Address - Country:US
Practice Address - Phone:406-752-1789
Practice Address - Fax:406-751-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9546291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT=========OtherLLC EMPLOYER NUMBER
MT=========OtherLLC EMPLOYER NUMBER