Basic Information
| Provider Information | |||||||||
| NPI: | 1124126024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLEASANT VALLEY PATHOLOGY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 VALLEY DR | ||||||||
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| City: | PT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255502031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046754340 | ||||||||
| FaxNumber: | 3046751328 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | PT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255502031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046754340 | ||||||||
| FaxNumber: | 3046751328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHAUER | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3046754340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 15018 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0672311 | 05 | OH | MEDICAID | 0008613000 | 05 | WV | MEDICAID |