Healthcare Provider Details

I. General information

NPI: 1497736151
Provider Name (Legal Business Name): PATHOLOGY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 FRANKLIN AVE
BISMARCK ND
58503-0761
US

IV. Provider business mailing address

3502 FRANKLIN AVE
BISMARCK ND
58503-0761
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-2480
  • Fax: 701-222-4537
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number35D0408903
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number35D2002387
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35D2002387
License Number State

VIII. Authorized Official

Name: WARD FREDRICKSON
Title or Position: PRESIDENT
Credential:
Phone: 701-222-2480