Provider Demographics
NPI:1851385892
Name:PATHOLOGY SERVICES OF SOUTHWEST VIRGINIA PC
Entity Type:Organization
Organization Name:PATHOLOGY SERVICES OF SOUTHWEST VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-953-5465
Mailing Address - Street 1:PO BOX 10776
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24062-0776
Mailing Address - Country:US
Mailing Address - Phone:540-767-2700
Mailing Address - Fax:540-767-2708
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-953-5465
Practice Address - Fax:540-953-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4000381000Medicaid
CG3681OtherRAILROAD MEDICARE
115189OtherSOUTHERN HEALTH
CG3681OtherRAILROAD MEDICARE