Organization
WESTERN PATHOLOGY ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CELENE MARIE ROBERTS MHRTD (OFFICE MANAGER)
(208) 233-3794
Entity
Organization
Contact information
Practice address
1950 E CLARK ST STE D, POCATELLO, ID 83201-3314
(208) 233-3794
(208) 233-3795
Mailing address
PO BOX 2537, POCATELLO, ID 83206-2537
(208) 233-3794
(208) 233-3795
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
207ZP0102X
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002467700
—
ID
Enumeration date
05/25/2007
Last updated
03/05/2010
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