Healthcare Provider Details

I. General information

NPI: 1811098957
Provider Name (Legal Business Name): CENTRAL PATHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E 31ST ST
KEARNEY NE
68847-2926
US

IV. Provider business mailing address

PO BOX 1857
NORTH PLATTE NE
69103-1857
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-7100
  • Fax:
Mailing address:
  • Phone: 308-647-6444
  • Fax: 866-902-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK D MOWRY
Title or Position: OWNER
Credential: D.O.
Phone: 308-865-7100