Healthcare Provider Details

I. General information

NPI: 1548228448
Provider Name (Legal Business Name): CLINICAL PATHOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

IV. Provider business mailing address

PO BOX 2910
WATERLOO IA
50704-2910
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-8852
  • Fax:
Mailing address:
  • Phone: 319-260-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM KASTEN
Title or Position: OWNER
Credential: M.D.
Phone: 319-272-8852