Healthcare Provider Details

I. General information

NPI: 1811155401
Provider Name (Legal Business Name): IDX PATHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 MILLER ST
BOISE ID
83702-6965
US

IV. Provider business mailing address

PO BOX 2240
BURLINGTON NC
27215
US

V. Phone/Fax

Practice location:
  • Phone: 800-222-7566
  • Fax:
Mailing address:
  • Phone: 800-222-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY WILLIAMS
Title or Position: VP
Credential:
Phone: 800-222-7566