NPIMap

Organization Active NPI

Cimarron Pathology PA

  • Clinical Medical Laboratory
  • Liberal, KS
National Provider Identifier
1629049648
Registry record updated Jul 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CIMARRON PATHOLOGY PA
Practice address
1436 N Western Ave
Liberal, KS 67901-2212
Phone
(620) 626-8500
NPI assigned
Jan 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2013

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

Authorized official

Name
Hubert Peterson, MDNPI 1891766812
Title
President
Phone
(620) 626-8500

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 Primary

Addresses

Primary practice location

1436 N Western Ave
Liberal, KS 67901-2212

Mailing address

PO Box 1699
Wichita, KS 67201-1699
Phone (800) 475-6236

Other identifiers 4

IdentifierTypeStateIssuer
100757940AMedicaidOK
690009229OtherRAILROAD MEDICARE
130243OtherKSBCBS
100328010AMedicaidKS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1138406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375056000000",
    "number": "1629049648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1699",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672011699",
            "telephone_number": "800-475-6236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 N WESTERN AVE",
            "city": "LIBERAL",
            "state": "KS",
            "postal_code": "679012212",
            "telephone_number": "620-626-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIMARRON PATHOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-28",
        "last_updated": "2013-07-29",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "HUBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "620-626-8500",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100757940A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "690009229",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "130243",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100328010A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberal, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; 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.