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General NPI Number Information
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NPI Number | 1306032891
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Entity Type | Organization
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Legal Business Name | SOUTHWESTERN PATHOLOGY ASSOCIATES
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 4704 NW MOTIF MANOR BLVD SUITE 7
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City | LAWTON
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State | OK
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Zip | 73505-4800
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Country | US
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Telephone | 580-536-0021
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Fax | 580-536-1024
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Provider Business Mailing Address
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Address Line | 4704 NW MOTIF MANOR BLVD SUITE 7
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City | LAWTON
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State | OK
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Zip | 73505-4800
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Country | US
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Telephone | 580-536-0021
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Fax | 580-536-1024
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Authorized Official
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Title or Position | DIRECTOR OF PATHOLOGY/OWNER
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Name | DR. MICHAEL C MCGINNIS
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Credential | M.D.
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Telephone | 580-536-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 19385
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 19385
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License Number State | OK
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