Provider Demographics
NPI:1700846680
Name:INNOVATIVE PATHOLOGY SERVICES PLLC
Entity Type:Organization
Organization Name:INNOVATIVE PATHOLOGY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BEUERLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-522-7591
Mailing Address - Street 1:PO BOX 60820
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-0820
Mailing Address - Country:US
Mailing Address - Phone:843-554-9300
Mailing Address - Fax:843-566-8780
Practice Address - Street 1:501 19TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1854
Practice Address - Country:US
Practice Address - Phone:865-522-7591
Practice Address - Fax:865-546-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29152207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3404216Medicaid
TN3404217Medicare PIN
TNP00037050Medicare PIN
TN3404216Medicare PIN