NPIMap

Organization Active NPI

Marlboro Chesterfield Pathology, PC

  • Clinical Medical Laboratory
  • Pinehurst, NC
National Provider Identifier
1619953965
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MARLBORO CHESTERFIELD PATHOLOGY, PC
Practice address
30 Page St.
Pinehurst, NC 28374-8449
Phone
(843) 479-2402
Fax
(843) 479-6609
NPI assigned
Dec 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

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

Authorized official

Name
Dr. Dell A Dembosky, MD.NPI 1639155971
Title
Owner
Phone
(843) 479-2402

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X SC Primary

Addresses

Primary practice location

30 Page St.
Pinehurst, NC 28374-8449

Mailing address

PO Box 4270
Pinehurst, NC 28370-8449
Phone (843) 479-2402

Other identifiers 3

IdentifierTypeStateIssuer
0120XOtherBSBS NC
890120XMedicaidNC
GP0789MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050929000695 NC Part B Supplier - Clinic/Group Practice 4486546819 Receives reassigned benefits from 9 practitioners
Practice locations: Pinehurst, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
42D0713042Marlboro Chesterfield Pathology PC30 Page Street, Pinehurst, NC 28374AccreditationApr 4, 2028

National Provider Directory

National Provider Directory

Locations

30 Page St
Pinehurst, NC 28374
Phone (910) 205-8000

1138 Cheraw St
Bennettsville, SC 29512
Phone (843) 454-8400

672 Highway 9 W
Bennettsville, SC 29512
Phone (843) 479-0641

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 11

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": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383091200000",
    "number": "1619953965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4270",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283708449",
            "telephone_number": "843-479-2402",
            "fax_number": "843-479-6609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 PAGE ST.",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283748449",
            "telephone_number": "843-479-2402",
            "fax_number": "843-479-6609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLBORO CHESTERFIELD PATHOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2013-10-30",
        "status": "A",
        "authorized_official_last_name": "DEMBOSKY",
        "authorized_official_first_name": "DELL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-479-2402",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSBS NC",
            "identifier": "0120X",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890120X",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0789",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pinehurst, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.