Provider Demographics
NPI:1659306504
Name:PEDIATRIC AND PERINATAL PATHOLOGY ASSOCIATES PSC
Entity Type:Organization
Organization Name:PEDIATRIC AND PERINATAL PATHOLOGY ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEBSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-456-6212
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE G71
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-456-6212
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-456-6212
Practice Address - Fax:502-456-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207ZP0101X, 207ZP0102X, 207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100007320AMedicaid
GA300039228AMedicaid
KY1050363OtherPASSPORT MEDICAID
MT3503214OtherMEDICAID MONTANA
FL909288900Medicaid
MI0112251Medicaid
KY7100232480Medicaid
DD1685OtherRAILROAD MEDICARE
1337243OtherUNITED MINE WORKERS
TN4281797Medicaid
KY000000059971OtherANTHEM BLUE CROSS BS
KY2425Medicare PIN