NPIMap

Organization Active NPI

Vista Pathology Laboratory, LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Gold Beach, OR
National Provider Identifier
1649544685
Registry record updated Apr 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
VISTA PATHOLOGY LABORATORY, LLC
Practice address
94220 4TH St
Gold Beach, OR 97444-7756
Phone
(800) 445-8085
NPI assigned
Mar 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2012

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

Authorized official

Name
Mrs. Shari L Brite
Title
Administrator
Phone
(541) 770-4559

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

94220 4TH St
Gold Beach, OR 97444-7756

Mailing address

PO Box 1000
Medford, OR 97501-0071
Phone (541) 770-4559

Other identifiers 1

IdentifierTypeStateIssuer
38D2036013OtherORCLIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120522001339 OR Part B Supplier - Clinic/Group Practice 4587827985 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gold Beach, OR; Grants Pass, OR; Medford, OR; Ashland, OR

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Vista Pathology Laboratory LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1032 E Jackson St
Medford, OR 97504
Phone (541) 770-4559

Practitioners & affiliated clinicians

Practitioners 12

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": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1649544685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975010071",
            "telephone_number": "541-770-4559",
            "fax_number": "541-770-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94220 4TH ST",
            "city": "GOLD BEACH",
            "state": "OR",
            "postal_code": "974447756",
            "telephone_number": "800-445-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA PATHOLOGY LABORATORY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "BRITE",
        "authorized_official_first_name": "SHARI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "541-770-4559",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "38D2036013",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gold Beach, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.