Provider Demographics
NPI:1538270772
Name:PATHOLOGY MEDICAL SERVICES PC
Entity type:Organization
Organization Name:PATHOLOGY MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-465-1957
Mailing Address - Street 1:PO BOX 82653
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68501-2653
Mailing Address - Country:US
Mailing Address - Phone:800-320-0935
Mailing Address - Fax:
Practice Address - Street 1:5440 SOUTH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2192
Practice Address - Country:US
Practice Address - Phone:402-465-1900
Practice Address - Fax:402-465-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28D0944195291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025160800Medicaid
NE099513Medicare ID - Type UnspecifiedMEDICARE IND LAB NUMBER