Basic Information
| Provider Information | |||||||||
| NPI: | 1720014087 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAGNOSTIC PATHOLOGY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94015 | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981249415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084728110 | ||||||||
| FaxNumber: | 2083441926 | ||||||||
| Practice Location | |||||||||
| Address1: | 3614 E NEWBY ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836879422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084662661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 02/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | KRONZ | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2084662661 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZP0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 806354500 | 05 | ID | MEDICAID |