NPIMap

Organization Active NPI

Indiana Pathology Consultants, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Fort Wayne, IN
National Provider Identifier
1467597062
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
50000730A Issued in IN
Legal business name
INDIANA PATHOLOGY CONSULTANTS, INC.
Practice address
7950 West Jefferson Blvd.
Pathology Department
Fort Wayne, IN 46804
Phone
(260) 435-7154
Fax
(260) 435-7633
NPI assigned
Feb 21, 2007
Last updated
Sep 28, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

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

Authorized official

Name
Mr. Max L Daniels
Title
Corporate Manager
Phone
(260) 432-5867

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 50000730A IN Primary

Addresses

Primary practice location

7950 West Jefferson Blvd.
Pathology Department
Fort Wayne, IN 46804

Mailing address

3240B Mallard Cove LN
Fort Wayne, IN 46804-2883
Phone (260) 432-5867

Other identifiers 2

IdentifierTypeStateIssuer
100053700BMedicaidIN
CN1365OtherRAILROAD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1467597062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240B MALLARD COVE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042883",
            "telephone_number": "260-432-5867",
            "fax_number": "260-436-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7950 WEST JEFFERSON BLVD.",
            "address_2": "PATHOLOGY DEPARTMENT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-435-7154",
            "fax_number": "260-435-7633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA PATHOLOGY CONSULTANTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "MAX",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CORPORATE MANAGER",
        "authorized_official_telephone_number": "260-432-5867",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "50000730A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100053700B",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "CN1365",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; 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.