Basic Information
| Provider Information | |||||||||
| NPI: | 1609121557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | USA PATHOLOGY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5052 W 4TH ST | ||||||||
| Address2: | STE 3 | ||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012612587 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5052 W 4TH ST | ||||||||
| Address2: | STE 3 | ||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012612587 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 07/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | KRATZ | ||||||||
| AuthorizedOfficialFirstName: | KURT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE MBR | ||||||||
| AuthorizedOfficialTelephone: | 6012612587 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 1225142920 | 01 | NPPES | OTHER | 1679556989 | 01 | NPPES | OTHER |