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General NPI Number Information
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NPI Number | 1811988025
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Entity Type | Organization
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Legal Business Name | WEST CENTRAL PATHOLOGY AND LABORATORY MEDICINE PA
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 111 17TH AVE E
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City | ALEXANDRIA
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State | MN
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Zip | 56308-3703
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Country | US
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Telephone | 320-762-6068
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Fax | 320-762-6145
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Provider Business Mailing Address
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Address Line | 2800 CAMPUS DR SUITE 150
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City | PLYMOUTH
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State | MN
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Zip | 55441-2606
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Country | US
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Telephone | 763-201-0492
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Fax |
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Authorized Official
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Title or Position | PATHOLOGIST
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Name | DR. MARK REID SPANBAUER
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Credential | MD
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Telephone | 320-762-6068
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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 | MN
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