Provider Demographics
NPI:1679871917
Name:PACIFIC PATHOLOGY PARTNERS, PLLC
Entity type:Organization
Organization Name:PACIFIC PATHOLOGY PARTNERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-447-5630
Mailing Address - Street 1:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-1037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3261 NW MOUNT VINTAGE WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6039
Practice Address - Country:US
Practice Address - Phone:360-447-5630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory