Active NPI
Histology Cytology Technical Lab of North Mississippi
- Anatomic Pathology & Clinical Pathology Physician
- Oxford, MS
National Provider Identifier
1578717674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 11854
- Legal business name
- HISTOLOGY CYTOLOGY TECHNICAL LAB OF NORTH MISSISSIPPI
- Practice address
- 2301 S Lamar Blvd
Oxford, MS 38655-5373 - Phone
- (662) 232-8121
- Fax
- (662) 236-5236
- NPI assigned
- Nov 17, 2008
- Last updated
- Dec 3, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. John P Fullenwider, M.D.
- Title
- Sole Proprietor
- Phone
- (800) 362-0858
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 11854 | MS | Primary |
Addresses
Primary practice location
2301 S Lamar Blvd
Oxford, MS 38655-5373
Mailing address
PO Box 428
Oxford, MS 38655-0428
Phone (662) 232-8121
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
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.
-
- Chiropractor
- Tinley Park, IL
- NPI 1598701534
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226880000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1228262400000",
"number": "1578717674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 428",
"city": "OXFORD",
"state": "MS",
"postal_code": "386550428",
"telephone_number": "662-232-8121",
"fax_number": "662-236-5236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 S LAMAR BLVD",
"city": "OXFORD",
"state": "MS",
"postal_code": "386555373",
"telephone_number": "662-232-8121",
"fax_number": "662-236-5236"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HISTOLOGY CYTOLOGY TECHNICAL LAB OF NORTH MISSISSIPPI",
"organizational_subpart": "NO",
"enumeration_date": "2008-11-17",
"last_updated": "2008-12-03",
"status": "A",
"authorized_official_last_name": "FULLENWIDER",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "SOLE PROPRIETOR",
"authorized_official_telephone_number": "800-362-0858",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MS",
"license": "11854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Oxford, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.