Provider Demographics
NPI:1407810518
Name:AFFILIATED PATHOLOGISTS PA
Entity Type:Organization
Organization Name:AFFILIATED PATHOLOGISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-384-6270
Mailing Address - Street 1:PO BOX 1867
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-1867
Mailing Address - Country:US
Mailing Address - Phone:940-384-6270
Mailing Address - Fax:940-382-7680
Practice Address - Street 1:1200 E PECAN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-6141
Practice Address - Country:US
Practice Address - Phone:940-384-6270
Practice Address - Fax:940-382-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100751010AMedicaid
TX121710101Medicaid
TX121710101Medicaid
OK100751010AMedicaid
OK=========0004OtherBCBS
TX121710101Medicaid
DA2426Medicare PIN
TX826223051Medicare PIN