Provider Demographics
NPI:1720055577
Name:PATHOLOGY ASSOCIATION OF LONGVIEW PA
Entity Type:Organization
Organization Name:PATHOLOGY ASSOCIATION OF LONGVIEW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCQUAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-758-8511
Mailing Address - Street 1:PO BOX 3187
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-3187
Mailing Address - Country:US
Mailing Address - Phone:903-758-8511
Mailing Address - Fax:903-757-5033
Practice Address - Street 1:700 EAST MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601
Practice Address - Country:US
Practice Address - Phone:903-315-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00E090Medicare ID - Type Unspecified