Provider Demographics
NPI:1881784734
Name:WESTSHORE PATHOLOGY SERVICES PLC
Entity type:Organization
Organization Name:WESTSHORE PATHOLOGY SERVICES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:REICHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-728-5758
Mailing Address - Street 1:1774 PECK STREET
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2533
Mailing Address - Country:US
Mailing Address - Phone:231-728-5758
Mailing Address - Fax:231-728-5636
Practice Address - Street 1:1774 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2533
Practice Address - Country:US
Practice Address - Phone:231-728-5758
Practice Address - Fax:231-728-5636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSHORE PATHOLOGY SERVICES PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPLAP2524601207ZP0102X
AUID1037588207ZP0102X
207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2099460Medicaid
MI0F11505Medicare PIN