Provider Demographics
NPI:1144311986
Name:KANSAS PATHOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:KANSAS PATHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARD
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:NEWCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-625-5026
Mailing Address - Street 1:1212 E 27TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2106
Mailing Address - Country:US
Mailing Address - Phone:785-650-3196
Mailing Address - Fax:303-957-5421
Practice Address - Street 1:1212 E 27TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2106
Practice Address - Country:US
Practice Address - Phone:785-625-5026
Practice Address - Fax:785-625-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17D0681749291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130560OtherMEDICARE PTAN
KS70 877836 01Medicaid
KS70 877836 01Medicaid