Provider Demographics
NPI:1013131572
Name:HENDERSON PATHOLOGY & CYTOPATHOLOGY SERVICES PSC
Entity Type:Organization
Organization Name:HENDERSON PATHOLOGY & CYTOPATHOLOGY SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR PATHOLOGY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:P
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORPUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-827-9701
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:1228 N ELM ST
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420
Mailing Address - Country:US
Mailing Address - Phone:270-827-5399
Mailing Address - Fax:270-827-5327
Practice Address - Street 1:1305 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420
Practice Address - Country:US
Practice Address - Phone:270-827-9701
Practice Address - Fax:270-883-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65905382Medicaid
6344Medicare PIN