Provider Demographics
NPI:1356346530
Name:COMMUNITY PATHOLOGY & NUCLEAR MEDICINE PC
Entity type:Organization
Organization Name:COMMUNITY PATHOLOGY & NUCLEAR MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOGUSLAW
Authorized Official - Middle Name:I
Authorized Official - Last Name:UCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-298-5172
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46015-0563
Mailing Address - Country:US
Mailing Address - Phone:765-640-1307
Mailing Address - Fax:765-640-1376
Practice Address - Street 1:1515 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3453
Practice Address - Country:US
Practice Address - Phone:765-298-5172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027944A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000103808OtherBLUE SHEILD
IN100173020AMedicaid
IN508530Medicare UPIN