Provider Demographics
NPI:1699822189
Name:WESTSHORE PATHOLOGY SERVICES PLC
Entity Type:Organization
Organization Name:WESTSHORE PATHOLOGY SERVICES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:REICHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-728-5758
Mailing Address - Street 1:1774 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2533
Mailing Address - Country:US
Mailing Address - Phone:231-728-5758
Mailing Address - Fax:231-728-5636
Practice Address - Street 1:1774 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2533
Practice Address - Country:US
Practice Address - Phone:231-728-5758
Practice Address - Fax:231-728-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F16024Medicare PIN