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Organization

MOLECULAR PATHOLOGY SERVICES OF THE HENRY VOGT CANCER RESEARCH INST

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. STEPHEN P SLONE MD (INTERIM DIRECTOR)
(502) 852-0029
Entity
Organization

Contact information

Practice address
529 S JACKSON ST, STE 417, LOUISVILLE, KY 40202-3229
(502) 852-7093
(502) 852-0886
Mailing address
529 S JACKSON ST, STE 417, LOUISVILLE, KY 40202-3229
(502) 852-7093
(502) 852-0886

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
200191
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000060628
ANTHEM PROV #
KY
01
1060980
PASSPORT PROVIDER #
KY
01
18D0648486
CLIA
KY
01
200043080A
IN MCD #
KY
01
2434185000
MEDICARE REPLACEMENT
KY
05
65945289
KY
Enumeration date
07/28/2005
Last updated
12/14/2009
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