Provider Demographics
NPI:1578909248
Name:COMMUNITY PATHOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:COMMUNITY PATHOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUACKENBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-684-4621
Mailing Address - Street 1:1005 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6408
Mailing Address - Country:US
Mailing Address - Phone:641-684-4621
Mailing Address - Fax:641-682-8976
Practice Address - Street 1:1005 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6408
Practice Address - Country:US
Practice Address - Phone:641-684-4621
Practice Address - Fax:641-682-8976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty