=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154393858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHOLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2006
-----------------------------------------------------
Last Update Date | 01/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 MERCY DR ROOM G211
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52004-0731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-556-2012
-----------------------------------------------------
Fax | 563-556-0986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 MERCY DR P O BOX 731
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52004-0731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-556-2012
-----------------------------------------------------
Fax | 563-556-0986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | CHRISTOPHER J LEIGH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 563-589-8614
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------