Basic Information
| Provider Information | |||||||||
| NPI: | 1992798854 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY PATHOLOGISTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 WYOMING STREET | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372249326 | ||||||||
| FaxNumber: | 9372241010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WYOMING STREET | ||||||||
| Address2: | MIAMI VALLEY HOSPITAL PATHOLOGY DEPT | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372082978 | ||||||||
| FaxNumber: | 9372086137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | BALAJ | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9372249326 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 207ZP0102X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | CI0037 | 01 | OH | RR MEDICARE | OTHER | 0572330 | 05 | OH | MEDICAID |