MEDICARE: OQUINN MEDICAL PATHOLOGY ASSOCIATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063484624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OQUINN MEDICAL PATHOLOGY ASSOCIATION LLC

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD
Second Line	:	SUITE 400
City	:	ADDISON
State	:	TX
Zip	:	75001-3614
Country	:	US
Telephone Number	:	214-932-8029
Fax Number	:	610-271-4245

Provider Business Practice Location Address
First Line	:	3651 WHEELER RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6521
Country	:	US
Telephone Number	:	706-651-6544
Fax Number	:	706-651-6158

Authorized Official
Title or Position	:	VP
Name	:	DR. EDWARD M KRAMER
Credential	:
Telephone Number	:	610-550-3000

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	04/24/2015

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