Organization
PATHLAB LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MAUREEN A. RUSHENBERG (PRESIDENT)
(712) 396-4422
Entity
Organization
Contact information
Practice address
933 EAST PIERCE ST., COUNCIL BLUFFS, IA 51503
(712) 396-6000
(712) 396-6288
Mailing address
PO BOX 2797, OMAHA, NE 68103-2797
(402) 354-4230
(402) 354-6171
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08955
WELLMARK
IA
Enumeration date
10/05/2006
Last updated
11/13/2020
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