Provider Demographics
NPI:1427011907
Name:PATHOLOGY SERVICES PA
Entity Type:Organization
Organization Name:PATHOLOGY SERVICES PA
Other - Org Name:DERMATOPATHOLOGY DIAGNOSTICS A DIVISION OF PATHOLOGY SERVICES PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOREL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-272-4783
Mailing Address - Street 1:5650 SW 29TH STREET
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2443
Mailing Address - Country:US
Mailing Address - Phone:785-272-4783
Mailing Address - Fax:785-272-4783
Practice Address - Street 1:5650 SW 29TH STREET
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2443
Practice Address - Country:US
Practice Address - Phone:785-272-4783
Practice Address - Fax:785-272-4783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0415028207ZC0500X, 207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
220010026OtherRR MEDICARE
KS100212900AMedicaid
KS003794Medicare ID - Type Unspecified