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NPI Code Detail

MEDICARE: WYOMING PATHOLOGY INC

MEDICARE: WYOMING PATHOLOGY INC
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1611967200OTHERWYDOL BLACK LUNG
286079OTHERWYALTIUS HEALTHCARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396751947
Entity Type Code : Organization
Provider Name (Legal Business Name) : WYOMING PATHOLOGY INC
Provider Business Mailing Address
First Line : PO BOX 270592
Second Line :
City : LOUISVILLE
State : CO
Zip : 80027-5009
Country : US
Telephone Number : 405-947-8584
Fax Number : 405-948-6507
Provider Business Practice Location Address
First Line : 255 N 30TH ST
Second Line :
City : LARAMIE
State : WY
Zip : 82072-5140
Country : US
Telephone Number : 307-742-2141
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. JAMES F MARTINCHICK
Credential : MD
Telephone Number : 307-742-2141
Provider Enumeration Date : 08/01/2006
Last Update Date : 01/28/2010

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Directions to “WYOMING PATHOLOGY INC ” Practice Location

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