Healthcare Provider Details

I. General information

NPI: 1831175389
Provider Name (Legal Business Name): ALLIED HOSPITAL PATHOLOGISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

2458 LAKE AVE
FORT WAYNE IN
46805-5406
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-1000
  • Fax:
Mailing address:
  • Phone: 260-424-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number50002503A
License Number StateIN

VIII. Authorized Official

Name: RACHEL A KEEFER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 260-424-2195