Basic Information
| Provider Information | |||||||||
| NPI: | 1508249228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAWD PATHOLOGY PARTNERS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 804910 | ||||||||
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| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641804910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162413338 | ||||||||
| FaxNumber: | 8169368118 | ||||||||
| Practice Location | |||||||||
| Address1: | 9705 LENEXA DR | ||||||||
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| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662151345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133968509 | ||||||||
| FaxNumber: | 9134959743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2015 | ||||||||
| LastUpdateDate: | 03/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | JEFF | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9133968509 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.