Organization
CIMARRON PATHOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HUBERT PETERSON MD (PRESIDENT)
(620) 626-8500
Entity
Organization
Contact information
Practice address
1436 N WESTERN AVE, LIBERAL, KS 67901-2212
(620) 626-8500
Mailing address
PO BOX 1699, WICHITA, KS 67201-1699
(800) 475-6236
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100328010A
—
KS
05
—
100757940A
—
OK
01
—
130243
BCBS
KS
01
—
690009229
RAILROAD MEDICARE
—
Enumeration date
01/28/2006
Last updated
07/29/2013
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