Organization
WEST CENTRAL PATHOLOGY AND LABORATORY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK REID SPANBAUER MD (PATHOLOGIST)
(320) 762-6068
Entity
Organization
Contact information
Practice address
111 17TH AVE E, ALEXANDRIA, MN 56308-3703
(320) 762-6068
(320) 762-6145
Mailing address
2800 CAMPUS DR, SUITE 150, PLYMOUTH, MN 55441-2606
(763) 201-0492
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113212100
—
MN
01
—
1134119324
NPI ENUMERATOR
MN
01
—
1619967890
NPI ENUMERATOR
MN
01
—
D197
UCARE
MN
01
—
DA8276
RR MEDICARE
MN
Enumeration date
11/04/2005
Last updated
07/21/2022
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