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General NPI Number Information
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NPI Number | 1629049648
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Entity Type | Organization
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Legal Business Name | CIMARRON PATHOLOGY PA
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Dates
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Enumeration Date | 01/28/2006
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 1436 N WESTERN AVE
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City | LIBERAL
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State | KS
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Zip | 67901-2212
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Country | US
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Telephone | 620-626-8500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1699
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City | WICHITA
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State | KS
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Zip | 67201-1699
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Country | US
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Telephone | 800-475-6236
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HUBERT PETERSON
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Credential | MD
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Telephone | 620-626-8500
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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 |
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License Number State |
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