Provider Demographics
NPI:1679563522
Name:PATHOLOGY ASSOCIATES OF PADUCAH, PSC
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF PADUCAH, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-575-2244
Mailing Address - Street 1:PO BOX 8317
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8317
Mailing Address - Country:US
Mailing Address - Phone:270-575-2244
Mailing Address - Fax:270-415-7130
Practice Address - Street 1:2501 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3813
Practice Address - Country:US
Practice Address - Phone:270-575-2244
Practice Address - Fax:270-415-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCA2520OtherMEDICARE RAILROAD
KY65922353Medicaid
KY65922353Medicaid