Renaissance Pathology Associates PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

115326 Issued in NC

Legal business name

RENAISSANCE PATHOLOGY ASSOCIATES PA

Practice address

117 E Kings Hwy
Eden, NC 27288-5201

Phone

(336) 623-9711

Fax

(336) 627-0900

NPI assigned

Sep 14, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mark Saunders Jordan, M.D.

Title

President

Phone

(336) 623-9711

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284336000000",
    "number": "1376648246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272890767",
            "telephone_number": "336-623-9711",
            "fax_number": "336-627-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 E KINGS HWY",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885201",
            "telephone_number": "336-623-9711",
            "fax_number": "336-627-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAISSANCE PATHOLOGY ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2010-09-13",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "SAUNDERS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-623-9711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "115326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Eden, NC
• Providers in Eden, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2010; 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.