Healthcare Provider Details

I. General information

NPI: 1649375189
Provider Name (Legal Business Name): PHENOPATH LABORATORIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 AIRPORT WAY S STE 201
SEATTLE WA
98134-1636
US

IV. Provider business mailing address

1201 S COLLEGEVILLE RD
COLLEGEVILLE PA
19426-2998
US

V. Phone/Fax

Practice location:
  • Phone: 206-374-9000
  • Fax: 206-774-3412
Mailing address:
  • Phone: 610-454-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberMTS-3261
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DARREN THOMAS WHEELER
Title or Position: PRESIDENT
Credential: MD
Phone: 702-733-7866