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General NPI Number Information
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NPI Number | 1194789867
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Entity Type | Organization
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Legal Business Name | MIDWEST PATHOLOGY SPECIALISTS PLC
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 4955 F STREET
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City | OMAHA
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State | NE
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Zip | 68117
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Country | US
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Telephone | 402-717-2875
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Fax | 402-717-5231
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Provider Business Mailing Address
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Address Line | PO BOX 4907
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City | OMAHA
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State | NE
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Zip | 68104
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Country | US
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Telephone | 800-831-2402
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Fax | 843-569-8503
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | DR. WAYNE PENKA
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Credential | MD
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Telephone | 402-717-2875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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