Western Idaho Pathology PA

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

Legal business name

WESTERN IDAHO PATHOLOGY PA

Practice address

1717 Arlington Ave
Caldwell, ID 83605-4802

Phone

(208) 455-3799

Fax

(310) 698-7040

NPI assigned

Sep 24, 2007

Organization subpart

No

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

Authorized official

Name

Joseph R Eastman III, MD

Title

President

Phone

(208) 455-3799

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224633600000",
    "number": "1275729261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 49009",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296490001",
            "telephone_number": "864-223-3070",
            "fax_number": "864-223-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 ARLINGTON AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054802",
            "telephone_number": "208-455-3799",
            "fax_number": "310-698-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN IDAHO PATHOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2008-10-22",
        "status": "A",
        "authorized_official_last_name": "EASTMAN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-455-3799",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8078528",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.