Provider Demographics
NPI:1740236264
Name:CENTRAL UTAH PATHOLOGY LLC
Entity type:Organization
Organization Name:CENTRAL UTAH PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-263-0810
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-0276
Mailing Address - Country:US
Mailing Address - Phone:801-263-0810
Mailing Address - Fax:801-270-8170
Practice Address - Street 1:1000 E 100 N
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1600
Practice Address - Country:US
Practice Address - Phone:801-263-0810
Practice Address - Fax:801-270-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========004Medicaid
UT=========004Medicaid
UT000055609Medicare PIN