Provider Demographics
NPI:1497271480
Name:IRL PATHOLOGY SERVICES MIDAMERICA, LLC
Entity Type:Organization
Organization Name:IRL PATHOLOGY SERVICES MIDAMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-508-4039
Mailing Address - Street 1:PO BOX 744327
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4327
Mailing Address - Country:US
Mailing Address - Phone:954-507-6780
Mailing Address - Fax:866-262-5507
Practice Address - Street 1:2316 E MEYER BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1136
Practice Address - Country:US
Practice Address - Phone:816-276-4593
Practice Address - Fax:816-276-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty