Provider Demographics
NPI:1619081767
Name:GLACIER REGIONAL PATHOLOGY, LTD.
Entity Type:Organization
Organization Name:GLACIER REGIONAL PATHOLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-752-1789
Mailing Address - Street 1:310 SUNNYVIEW LANE
Mailing Address - Street 2:PATHOLOGY DEPARTMENT
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3129
Mailing Address - Country:US
Mailing Address - Phone:406-752-1789
Mailing Address - Fax:406-751-5776
Practice Address - Street 1:310 SUNNYVIEW LANE
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3129
Practice Address - Country:US
Practice Address - Phone:406-752-1789
Practice Address - Fax:406-751-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000081066Medicare PIN