Basic Information
| Provider Information | |||||||||
| NPI: | 1184132292 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST PATHOLOGY PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3614 MERIDIAN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607342800 | ||||||||
| FaxNumber: | 3607343818 | ||||||||
| Practice Location | |||||||||
| Address1: | 3614 MERIDIAN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607342800 | ||||||||
| FaxNumber: | 3607343818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2018 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | HARBER-MURPHY | ||||||||
| AuthorizedOfficialFirstName: | PHYLLIS | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 3605274507 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTHWEST PATHOLOGY PS | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZN0500X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Neuropathology | 207ZP0101X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0105X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | 207ZB0001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZC0006X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | 207ZH0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | MTSA.FS.00004378 | 01 | WA | CLIA CERTIFICATION - NWP PS | OTHER | MTSA.FS.60342115 | 01 | WA | CLIA CERTIFICATION - PHSJMC | OTHER | MTSA.FS.60342113 | 01 | WA | CLIA CERTIFICATION -OMC | OTHER | MTSC.FS.60598310 | 01 | WA | CLIA CERTIFICATION - MOUNT VERNON | OTHER | MTSA.FS.60920920 | 01 | WA | CLIA CERTIFICATION - NWL | OTHER |