NPIMap

Organization Active NPI

Pathologists Diagnostic Laboratory PA

  • Clinical Medical Laboratory
  • Winston Salem, NC
National Provider Identifier
1437424975
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PATHOLOGISTS DIAGNOSTIC LABORATORY PA
Practice address
630 Brookwood Business Park Dr
Winston Salem, NC 27105-4478
Phone
(336) 999-8888
Fax
(336) 999-8889
NPI assigned
Mar 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Authorized official

Name
Mrs. Carla N Smith
Title
Client Services Manager
Phone
(336) 999-8888

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

630 Brookwood Business Park Dr
Winston Salem, NC 27105-4478

Mailing address

PO Box 30369
Winston Salem, NC 27130-0369
Phone (369) 998-8883

Other identifiers 3

IdentifierTypeStateIssuer
010345456MedicaidVA
L00213MedicaidSC
7001277MedicaidNC

Other names 1

  • Atlantic Pathology Services PA Former legal business name

National Provider Directory

National Provider Directory

Locations

3195 Maplewood Ave
Ste 201
Winston Salem, NC 27103

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606176000000",
    "number": "1437424975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30369",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271300369",
            "telephone_number": "369-998-8883",
            "fax_number": "369-998-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 BROOKWOOD BUSINESS PARK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271054478",
            "telephone_number": "336-999-8888",
            "fax_number": "336-999-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGISTS DIAGNOSTIC LABORATORY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CARLA",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CLIENT SERVICES MANAGER",
        "authorized_official_telephone_number": "336-999-8888",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010345456",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L00213",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7001277",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantic Pathology Services PA",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Atlantic Pathology Services PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; 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.