Provider Demographics
NPI:1679657118
Name:ACCUPATH LABORATORY SERVICES, INC
Entity Type:Organization
Organization Name:ACCUPATH LABORATORY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSELBRACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-365-5177
Mailing Address - Street 1:10740 MERIDIAN AVE N
Mailing Address - Street 2:#G3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9010
Mailing Address - Country:US
Mailing Address - Phone:206-365-5177
Mailing Address - Fax:206-362-0943
Practice Address - Street 1:10740 MERIDIAN AVE N
Practice Address - Street 2:#G3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9010
Practice Address - Country:US
Practice Address - Phone:206-365-5177
Practice Address - Fax:206-362-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00008894291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7058969Medicaid
WAP00685540OtherRAILROAD MEDICARE
WA7058969Medicaid
WAG000100029Medicare PIN