NPIMap

Organization Active NPI

Fond Du Lac Pathology Consultants

  • Anatomic Pathology & Clinical Pathology Physician
  • Fond Du Lac, WI
National Provider Identifier
1619052800
Registry record updated Jan 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
FOND DU LAC PATHOLOGY CONSULTANTS
Practice address
430 E Division St
St Agnes Hosp, Pathology Dept
Fond Du Lac, WI 54935-4560
Phone
(920) 926-5840
Fax
(920) 929-0647
NPI assigned
Oct 26, 2006
Last updated
Jan 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2014

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

Authorized official

Name
Dr. Jonathan Gedye, MDNPI 1447337340
Title
President
Phone
(920) 926-5800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

430 E Division St
St Agnes Hosp, Pathology Dept
Fond Du Lac, WI 54935-4560

Mailing address

PO Box 107
Fond Du Lac, WI 54936-0107
Phone (920) 929-9300

Other identifiers 2

IdentifierTypeStateIssuer
31770700MedicaidWI
CO1718OtherWIRR MEDICARE

National Provider Directory

National Provider Directory

Locations

45 Sheboygan St
Fond du Lac, WI 54935

Practitioners & affiliated clinicians

Practitioners 5

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": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389225600000",
    "number": "1619052800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 107",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549360107",
            "telephone_number": "920-929-9300",
            "fax_number": "920-923-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "address_2": "ST AGNES HOSP, PATHOLOGY DEPT",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-5840",
            "fax_number": "920-929-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC PATHOLOGY CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2014-01-09",
        "status": "A",
        "authorized_official_last_name": "GEDYE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-926-5800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31770700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CO1718",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; 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.