Organization
WEST CENTRAL PATHOLOGY AND LABORATORY MEDICINE PA
Active
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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