Provider Demographics
NPI:1477735850
Name:MIDWEST PATHOLOGY SERVICES
Entity type:Organization
Organization Name:MIDWEST PATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-732-6223
Mailing Address - Street 1:8121 NATIONAL AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7530
Mailing Address - Country:US
Mailing Address - Phone:405-732-6223
Mailing Address - Fax:
Practice Address - Street 1:8121 NATIONAL AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7530
Practice Address - Country:US
Practice Address - Phone:405-732-6223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1477735850OtherBLUE CROSS BLUE SHIELD
OK1477735850OtherRAILROAD MEDICARE
OK1477735850Medicaid
OK1477735850OtherRAILROAD MEDICARE