Basic Information
Provider Information
NPI: 1972707263
EntityType: 2
ReplacementNPI:  
OrganizationName: MARTIN HOSPITAL CORPORATION
LastName:  
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MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: VOLUNTEER COMMUNITY HOSPITAL PATHOLOGY
OtherOrganizationType: 3
OtherLastName:  
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Mailing Information
Address1: PO BOX 501067
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631500001
CountryCode: US
TelephoneNumber: 6608265960
FaxNumber:  
Practice Location
Address1: 161 MOUNT PELIA RD
Address2:  
City: MARTIN
State: TN
PostalCode: 382373811
CountryCode: US
TelephoneNumber: 7315874261
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/12/2007
LastUpdateDate: 09/10/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HUSSEY
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 6154657000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0105X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine

No ID Information.


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