NPIMap

Organization Active NPI

Matrix Pathology and Laboratory Services PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Manchester, NH
National Provider Identifier
1083157341
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
759903 Issued in NH
Legal business name
MATRIX PATHOLOGY AND LABORATORY SERVICES PLLC
Practice address
100 McGregor St
Manchester, NH 03102-3730
Phone
(603) 663-8174
NPI assigned
Nov 18, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Weldon Sanford, M.D.NPI 1134161383
Title
Owner
Phone
(603) 732-8656

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X 759903 NH Primary

Addresses

Primary practice location

100 McGregor St
Manchester, NH 03102-3730

Mailing address

4 Harvest VW
Amherst, NH 03031-3343
Phone (603) 732-8656

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170109000751 NH Part B Supplier - Clinic/Group Practice 5698056554 Receives reassigned benefits from 4 practitioners
Practice locations: Manchester, NH; Peterborough, NH

National Provider Directory

National Provider Directory

Locations

100 McGregor St
Ste 210
Manchester, NH 03102

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 64

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479427200000",
    "number": "1083157341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 HARVEST VW",
            "city": "AMHERST",
            "state": "NH",
            "postal_code": "030313343",
            "telephone_number": "603-732-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MCGREGOR ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031023730",
            "telephone_number": "603-663-8174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATRIX PATHOLOGY AND LABORATORY SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-18",
        "last_updated": "2016-11-18",
        "status": "A",
        "authorized_official_last_name": "SANFORD",
        "authorized_official_first_name": "WELDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-732-8656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NH",
            "license": "759903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.