Basic Information
| Provider Information | |||||||||
| NPI: | 1457781825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST CLINICAL PATHOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3614 MERIDIAN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607342800 | ||||||||
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| Address1: | 3614 MERIDIAN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607342800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2013 | ||||||||
| LastUpdateDate: | 11/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | HOYT | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3607342800 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTHWEST PATHOLOGY, PS | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0006X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | 207ZP0105X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
No ID Information.