Basic Information
| Provider Information | |||||||||
| NPI: | 1609859560 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE PATHOLOGY SERVICES LC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 842049 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CIY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641842049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148218055 | ||||||||
| FaxNumber: | 3148211833 | ||||||||
| Practice Location | |||||||||
| Address1: | 6420 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147688202 | ||||||||
| FaxNumber: | 3147687145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 10/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | BABICH | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3147688202 | ||||||||
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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 | 291U00000X | 26D0437653 | MO | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 26D0045374 | MO | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 042938 | 01 | MO | HEALTH ALLIANCE | OTHER | 208837211 | 05 | MO | MEDICAID | 7556 | 01 | MO | HEALTHCARE USA | OTHER | 9801344 | 01 | UHC | OTHER | 373987 | 01 | HEALTH LINK | OTHER | CI2882 | 01 | TRAVELERS | OTHER | 29381 | 01 | GHP | OTHER |