Healthcare Provider Details

I. General information

NPI: 1992787030
Provider Name (Legal Business Name): PUGET SOUND INSTITUTE OF PATHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 KLICKITAT WAY SW #205 PUGET SOUND INSTITUTE OF PATHOLOGY
SEATTLE WA
98134
US

IV. Provider business mailing address

PO BOX 34245 PSIP PLLC
SEATTLE WA
98124-1245
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-7747
  • Fax: 206-467-1470
Mailing address:
  • Phone: 206-622-7747
  • Fax: 206-467-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberCLIA 5000633091
License Number StateWA

VIII. Authorized Official

Name: KENNETH A MECKLER
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 206-622-7747