=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316013956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATHOLOGY ASSOCIATES OF STURDY MEMORIAL HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 04/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 PARK STREET
-----------------------------------------------------
City | ATTLEBORO
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02703-3143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-222-5200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 291 MOODY STREET
-----------------------------------------------------
City | LUDLOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01056-1246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-688-6663
-----------------------------------------------------
Fax | 413-589-0761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RICHARD A SMITH
-----------------------------------------------------
Credential | MD PHD MBA
-----------------------------------------------------
Telephone | 508-222-5200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------