Healthcare Provider Details

I. General information

NPI: 1760679443
Provider Name (Legal Business Name): ASSOCIATES OF PATHOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5475 S 500 E
OGDEN UT
84405-6905
US

IV. Provider business mailing address

6112 S 1550 E STE 3
SOUTH OGDEN UT
84405-5018
US

V. Phone/Fax

Practice location:
  • Phone: 435-734-0101
  • Fax: 801-317-4872
Mailing address:
  • Phone: 435-734-0101
  • Fax: 801-317-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number46D0660903
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number46D0660903
License Number StateUT

VIII. Authorized Official

Name: KRISTINE BERRETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 435-734-0101