Provider Demographics
NPI:1902997299
Name:SALMON FALLS PATHOLOGY LLC
Entity Type:Organization
Organization Name:SALMON FALLS PATHOLOGY LLC
Other - Org Name:SALMON FALLS PATHOLOGY PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-332-7303
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-5363
Practice Address - Street 1:15 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867
Practice Address - Country:US
Practice Address - Phone:603-335-8195
Practice Address - Fax:603-330-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
607638OtherTUFTS HEALTH PLAN
NH30008982Medicaid
MA9757881Medicaid
604295100OtherFED WORKERS COMP
ME142720000Medicaid
NHRE3971Medicare ID - Type Unspecified
MA9757881Medicaid