Provider Demographics
NPI:1548224009
Name:PINEHURST PATHOLOGY CENTER INC
Entity Type:Organization
Organization Name:PINEHURST PATHOLOGY CENTER INC
Other - Org Name:PINEHURST PATHOLOGY CENTER INC INDEPENDENT LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:JUSTINE
Authorized Official - Last Name:DIFURIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-715-1156
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-1156
Practice Address - Fax:910-715-1944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINEHURST PATHOLOGY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902399Medicaid
NC02399OtherBCBS
NC8902399Medicaid
NC204239Medicare PIN