Healthcare Provider Details

I. General information

NPI: 1174564025
Provider Name (Legal Business Name): LOWER COLUMBIA PATHOLOGISTS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 14TH AVE
LONGVIEW WA
98632
US

IV. Provider business mailing address

PO BOX 3012
LONGVIEW WA
98632
US

V. Phone/Fax

Practice location:
  • Phone: 360-425-5620
  • Fax: 360-425-7219
Mailing address:
  • Phone: 360-425-5620
  • Fax: 360-425-7219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHEILA D LYNAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 360-501-8306