MEDICARE: AFFILIATES IN PATHOLOGY SC

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		KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DC1348	OTHER	KY	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000317622	OTHER	KY	BCBS KY PIN

General Provider Information

NPI Number	:	1982609640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATES IN PATHOLOGY SC

Provider Business Mailing Address
First Line	:	100 FOUNTAIN AVE
Second Line	:	STE 300
City	:	PADUCAH
State	:	KY
Zip	:	42001-2771
Country	:	US
Telephone Number	:	270-442-9519
Fax Number	:	314-631-4491

Provider Business Practice Location Address
First Line	:	1530 LONE OAK RD
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-7901
Country	:	US
Telephone Number	:	270-442-9519
Fax Number	:	314-631-4491

Authorized Official
Title or Position	:	PRESIDENT/PROVIDER
Name	:	DR. STANLEY SPREI
Credential	:	MD
Telephone Number	:	270-442-9519

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/21/2022

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Directions to “AFFILIATES IN PATHOLOGY SC ” Practice Location

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