Healthcare Provider Details

I. General information

NPI: 1326086745
Provider Name (Legal Business Name): INCYTE PATHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15912 E MARIETTA AVE
SPOKANE VALLEY WA
99216-2552
US

IV. Provider business mailing address

PO BOX 3405
SPOKANE WA
99220-3405
US

V. Phone/Fax

Practice location:
  • Phone: 509-753-7222
  • Fax: 509-342-2743
Mailing address:
  • Phone: 509-753-7222
  • Fax: 509-342-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMTS0435
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberMTS0435
License Number StateWA

VIII. Authorized Official

Name: CORY MOSS
Title or Position: COO
Credential:
Phone: 509-868-9951