Peterson Laboratory Services, PA

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

17D0449919 Issued in KS

Legal business name

PETERSON LABORATORY SERVICES, PA

Practice address

1133 College Ave
Manhattan, KS 66502-2770

Phone

(785) 539-5363

Fax

(785) 539-5862

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

Stanley J. Werner

Title

Administrator

Phone

(785) 539-5363

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Peterson Clinical Laboratory, PA Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330992000000",
    "number": "1699794669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 COLLEGE AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665022770",
            "telephone_number": "785-539-5363",
            "fax_number": "785-539-5862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 COLLEGE AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665022770",
            "telephone_number": "785-539-5363",
            "fax_number": "785-539-5862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON LABORATORY SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2012-03-06",
        "status": "A",
        "authorized_official_last_name": "WERNER",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "785-539-5363"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "KS",
            "license": "17D0449919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100095750B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "690077064",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peterson Clinical Laboratory, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Gwendolyn B Pescini, LCPC
• Anita Kay Peterman, MS, LPC
• Heather Petermann, AUTISM SPECIALIST
• Clark Allen Petersen, D.C.
• Peterson Laboratory Services, PA
• Jennifer Peterson, APRN-C
• Katherine K Peterson, SLP
• Peggy S Peterson, D.O.
• Victoria J Pettay
• Kelli Renae Pettijohn

• Anatomic Pathology & Clinical Pathology Physician in Manhattan, KS
• Providers in Manhattan, KS by specialty
• Anatomic Pathology & Clinical Pathology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; 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.