Provider Demographics
NPI:1508249228
Name:MAWD PATHOLOGY PARTNERS PA
Entity Type:Organization
Organization Name:MAWD PATHOLOGY PARTNERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-396-8509
Mailing Address - Street 1:PO BOX 804910
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-4910
Mailing Address - Country:US
Mailing Address - Phone:816-241-3338
Mailing Address - Fax:816-936-8118
Practice Address - Street 1:9705 LENEXA DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1345
Practice Address - Country:US
Practice Address - Phone:913-396-8509
Practice Address - Fax:913-495-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty