Provider Demographics
NPI:1902885361
Name:SOUTHWESTERN PATHOLOGISTS, INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN PATHOLOGISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-352-2165
Mailing Address - Street 1:219 DELLWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3522
Mailing Address - Country:US
Mailing Address - Phone:800-554-2695
Mailing Address - Fax:
Practice Address - Street 1:1141 N MONROE DR
Practice Address - Street 2:GREENE MEMORIAL HOSPITAL PATH DEPT
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1619
Practice Address - Country:US
Practice Address - Phone:937-372-8011
Practice Address - Fax:937-352-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721508Medicaid
OHCB1381OtherRR MEDICARE
OHCB1381OtherRR MEDICARE
OH7900327Medicare PIN