Provider Demographics
NPI:1790787935
Name:YELLOWSTONE PATHOLOGY INSTITUTE, INC.
Entity Type:Organization
Organization Name:YELLOWSTONE PATHOLOGY INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA,MBA
Authorized Official - Phone:406-238-6360
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:STE 295W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7504
Mailing Address - Country:US
Mailing Address - Phone:406-238-6360
Mailing Address - Fax:406-238-6361
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:STE 295W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6360
Practice Address - Fax:406-238-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCLIA 27D0946844291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT420495Medicaid
MT690009017Medicare PIN
MT2445Medicare ID - Type Unspecified