Provider Demographics
NPI:1487663910
Name:INTERPATH, P.C.
Entity Type:Organization
Organization Name:INTERPATH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MURPHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-298-4214
Mailing Address - Street 1:PO BOX 2246
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-2246
Mailing Address - Country:US
Mailing Address - Phone:801-298-4214
Mailing Address - Fax:801-298-4217
Practice Address - Street 1:576 W 900 S
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84010-8194
Practice Address - Country:US
Practice Address - Phone:801-298-4214
Practice Address - Fax:801-298-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT46D0660897291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806113400Medicaid
UT=========004Medicaid
UT=========004Medicaid
ID806113400Medicaid