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General NPI Number Information
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NPI Number | 1508129628
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Entity Type | Organization
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Legal Business Name | CELLNETIX PATHOLOGY, PLLC
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 2490 S WOODWORTH LOOP SUITE 410
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City | PALMER
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State | AK
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Zip | 99645-7405
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Country | US
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Telephone | 866-236-8296
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Fax |
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Provider Business Mailing Address
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Address Line | 1124 COLUMBIA ST SUITE 200
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City | SEATTLE
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State | WA
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Zip | 98104-2026
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Country | US
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Telephone | 866-236-8296
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | J RANDALL BOREK
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Credential |
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Telephone | 206-576-6138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZD0900X
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Taxonomy Name | Dermatopathology (Pathology) 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 | 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 #3
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Taxonomy Code | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207ZP0007X
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Taxonomy Name | Molecular Genetic Pathology (Pathology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207ZI0100X
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Taxonomy Name | Immunopathology Physician
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License Number |
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License Number State |
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Taxonomy #6
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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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