Provider Demographics
NPI:1831173202
Name:SOUTHERN OHIO PATHOLOGY CONSULTANTS INC
Entity type:Organization
Organization Name:SOUTHERN OHIO PATHOLOGY CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:PANKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-872-1400
Mailing Address - Street 1:PO BOX 632242
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2242
Mailing Address - Country:US
Mailing Address - Phone:800-503-6254
Mailing Address - Fax:
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-872-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCA1041OtherRAILROAD MEDICARE
OH000000016917OtherBCBS
KY65923773Medicaid
OH2076784Medicaid
OH9269222Medicare PIN
OH8269224Medicare PIN
OH000000016917OtherBCBS
OHCA1041OtherRAILROAD MEDICARE