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Organization

MIDWEST PATHOLOGY SPECIALISTS PLC

Active
Other names
None
Organization subpart
No

Provider details

NPI number
Authorized official
DR. WAYNE PENKA MD (BILLING SPECIALIST)
(402) 717-2875
Entity
Organization

Contact information

Practice address
4955 F STREET, OMAHA, NE 68117
(402) 717-2875
(402) 717-5231
Mailing address
PO BOX 4907, OMAHA, NE 68104
(800) 831-2402
(843) 569-8503

Taxonomy

Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0508986
IA
01
44191
BCBS
IA
01
CD8493
RR MEDICARE
Enumeration date
04/12/2006
Last updated
01/26/2015
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