MEDICARE: INTEGRITY PATHOLOGY 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	207ZP0101X	Anatomic Pathology Physician	MD00034088	WA

General Provider Information

NPI Number	:	1366871402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY PATHOLOGY LLC

Provider Business Mailing Address
First Line	:	7620 OVERLAKE DR W
Second Line	:
City	:	MEDINA
State	:	WA
Zip	:	98039-4733
Country	:	US
Telephone Number	:	425-457-0250
Fax Number	:

Provider Business Practice Location Address
First Line	:	7620 OVERLAKE DR W
Second Line	:
City	:	MEDINA
State	:	WA
Zip	:	98039-4733
Country	:	US
Telephone Number	:	425-457-0250
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PATHOLOGIST
Name	:	DR. DOUGLAS ALAN HANSEN
Credential	:	MD
Telephone Number	:	425-457-0250

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/14/2013

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