Southwest Pathology, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SOUTHWEST PATHOLOGY, INC

Practice address

8803 S. 101St E. Ave
Suite 360
Tulsa, OK 74133

Phone

(918) 582-0001

Fax

(918) 582-0003

NPI assigned

Sep 12, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Melvin J Van Boven, DONPI 1003910522

Title

Authorized Official

Phone

(918) 582-0001

Specialties & licenses 2

Addresses

Other identifiers 6

Locations

Practitioners 3

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

• Melvin J Vanboven, DO

  • Anatomic Pathology & Clinical Pathology Physician
  • Tulsa, OK
  • NPI 1003910522
  NPD (past) Authorized official
• Anthony Alfrey, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Tulsa, OK
  • NPI 1245334887
  NPD (past)
• Steve E Rose, DO

  • Anatomic Pathology & Clinical Pathology Physician
  • Tulsa, OK
  • NPI 1245334739
  NPD (past)

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628640000000",
    "number": "1356445969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26303",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731260303",
            "telephone_number": "918-582-0001",
            "fax_number": "918-582-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8803 S. 101ST E. AVE",
            "address_2": "SUITE 360",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74133",
            "telephone_number": "918-582-0001",
            "fax_number": "918-582-0003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST PATHOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2021-08-11",
        "certification_date": "2021-08-11",
        "status": "A",
        "authorized_official_last_name": "VAN BOVEN",
        "authorized_official_first_name": "MELVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "918-582-0001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100739510A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100245110A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "703687004",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "4033986",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4033986",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "175079901",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Southwestern Regional Hospital
• Southwestern Regional Medical Center, LLC
• Stephanie P Souvannachak-Cowick, OD
• Shannon Kathleen Sova, DPT

• Clinical Medical Laboratory in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Clinical Medical Laboratory in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2021; 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.