Provider Demographics
NPI:1598056889
Name:YORK PATHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:YORK PATHOLOGY ASSOCIATES LLC
Other - Org Name:YORK CLINICAL PATHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-329-1234
Mailing Address - Street 1:222 S HERLONG AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1158
Mailing Address - Country:US
Mailing Address - Phone:803-329-1234
Mailing Address - Fax:803-327-7598
Practice Address - Street 1:222 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1158
Practice Address - Country:US
Practice Address - Phone:803-329-1234
Practice Address - Fax:803-327-7598
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YORK PATHOLOGY ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-21
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA5529Medicaid
SC2417Medicare PIN