Provider Demographics
NPI:1245263243
Name:GLOVER, KELTY & SCHULTHEIS MDS
Entity type:Organization
Organization Name:GLOVER, KELTY & SCHULTHEIS MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:MERRITT
Authorized Official - Last Name:SCHULTHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-373-8582
Mailing Address - Street 1:PO BOX 29019
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91209-9019
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:215 W JANSS RD
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1847
Practice Address - Country:US
Practice Address - Phone:805-373-8582
Practice Address - Fax:805-373-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080780Medicaid
CAGR0080780Medicaid