NPIMap

Individual provider Active NPI

George Jenfu Wang, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Russellville, AR
National Provider Identifier
1295175388
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
E-12605 Issued in AR
Practice address
1430 W C St
Russellville, AR 72801-2805
Phone
(800) 874-4904
NPI assigned
Jul 3, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X 29967 NE
Cytopathology Physician 207ZC0500X E-12605 AR
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X E-12605 AR Primary

Addresses

Primary practice location

1430 W C St
Russellville, AR 72801-2805

Mailing address

1430 W C St
Russellville, AR 72801-2805
Phone (800) 874-4904

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191111001473 AR Practitioner - Pathology 9638501711 Reassigns benefits to 1 organization
I20250812004613 CA Practitioner - Pathology 9638501711 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Temple University School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Redding PathologistsGroup PAC ID 6204738511, 5 clinicians

Practice addresses (Care Compare)

2036 Railroad Ave
Redding, CA 96001-1801
Phone (530) 255-1000

Hospital & facility affiliations

  • Mercy Medical Center Redding Hospital, Redding, CA, CCN 050280
  • Shasta Regional Medical Center Hospital, Redding, CA, CCN 050764
  • St Elizabeth Community Hospital Hospital, Red Bluff, CA, CCN 050042
  • Mercy Medical Center of Mt Shasta Hospital, Mount Shasta, CA, CCN 051319

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
E-12605ARMDCytopathology Physician
29967NEMDCytopathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Redding Pathologists Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2025 Accepting new patients
Pathology Services Laboratory PA Anatomic Pathology & Clinical Pathology CurrentSince Sep 23, 2019 Accepting new patients
Pathology Services Laboratory PA Anatomic Pathology & Clinical Pathology CurrentSince Sep 23, 2019 Accepting new patients
Nuclear Medicine Associates Past Accepting new patients
Last Frontier Healthcare District Past Accepting new patients

Locations

1430 W C St
Russellville, AR 72801
Phone (479) 968-6781

2036 Railroad Ave
Redding, CA 96001
Phone (530) 225-8050

5700 Southwyck Blvd
Toledo, OH 43614

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1295175388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 W C ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012805",
            "telephone_number": "800-874-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 W C ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012805",
            "telephone_number": "800-874-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANG",
        "first_name": "GEORGE",
        "middle_name": "JENFU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-03",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "NE",
            "license": "29967",
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "AR",
            "license": "E-12605",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AR",
            "license": "E-12605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

Verify at the official NPI Registry.