Healthcare Provider Details

I. General information

NPI: 1114994290
Provider Name (Legal Business Name): WESTERN PATHOLOGY SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 E JOHNSON ST
GARDEN CITY KS
67846-4746
US

IV. Provider business mailing address

PO BOX 1876
WICHITA KS
67201-1876
US

V. Phone/Fax

Practice location:
  • Phone: 800-475-6236
  • Fax:
Mailing address:
  • Phone: 316-685-8428
  • Fax: 316-652-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: EVA VACHAL
Title or Position: PRESIDENT
Credential: MD
Phone: 620-272-2263