Healthcare Provider Details

I. General information

NPI: 1801528351
Provider Name (Legal Business Name): CAPITOL PATHOLOGY SPECIALISTS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 05/06/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 104TH ST
KANSAS CITY MO
64131-4517
US

IV. Provider business mailing address

2203 TWIN OAKS DR APT 67
HARRISONVILLE MO
64701-2972
US

V. Phone/Fax

Practice location:
  • Phone: 202-744-5124
  • Fax:
Mailing address:
  • Phone: 202-744-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: BETTY SUE CAGLE
Title or Position: PRESIDENT
Credential: PHD, MD
Phone: 202-744-5124