NPIMap

Organization Active NPI

Pathology Laboratory, P.C.

  • Clinical Medical Laboratory
  • Grand Rapids, MI
National Provider Identifier
1285618447
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
23D0380021 Issued in MI
Legal business name
PATHOLOGY LABORATORY, P.C.
Doing business as
Pathology Laboratory, P.C.
Practice address
2620 Horizon Drive SE
Suite 100
Grand Rapids, MI 49546-7936
Phone
(616) 530-3344
Fax
(616) 530-0575
NPI assigned
Dec 1, 2005
Last updated
Jun 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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

Authorized official

Name
Dr. Kim A. Mills, M.D.NPI 1386637692
Title
President
Phone
(616) 530-3344

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X 23D0380021 MI
Clinical Medical Laboratory 291U00000X 23D0380021 MI Primary

Addresses

Primary practice location

2620 Horizon Drive SE
Suite 100
Grand Rapids, MI 49546-7936

Mailing address

2620 Horizon Dr SE
Suite 100
Grand Rapids, MI 49546-7520
Phone (616) 530-3344

Other names 1

  • PATHOLOGY LABORATORY, P.C. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060424000158 MI Part B Supplier - Clinic/Group Practice 7315957289 Receives reassigned benefits from 10 practitioners
Practice locations: Grand Rapids, MI

National Provider Directory

National Provider Directory

Locations

2620 Horizon Dr SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 530-3344

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1285618447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 HORIZON DR SE",
            "address_2": "SUITE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467520",
            "telephone_number": "616-530-3344",
            "fax_number": "616-530-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 HORIZON DRIVE SE",
            "address_2": "SUITE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467936",
            "telephone_number": "616-530-3344",
            "fax_number": "616-530-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY LABORATORY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-01",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-530-3344",
        "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": "MI",
            "license": "23D0380021",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MI",
            "license": "23D0380021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PATHOLOGY LABORATORY, P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.