Provider Demographics
NPI:1811098957
Name:CENTRAL PATHOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:CENTRAL PATHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:308-865-7100
Mailing Address - Street 1:PO BOX 1857
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-1857
Mailing Address - Country:US
Mailing Address - Phone:308-647-6444
Mailing Address - Fax:866-902-2445
Practice Address - Street 1:10 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-2926
Practice Address - Country:US
Practice Address - Phone:308-865-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025121200Medicaid
NE10025121200Medicaid