Basic Information
| Provider Information | |||||||||
| NPI: | 1215993381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AKRON PATHOLOGY ASSOC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30701 LORAIN RD STE A | ||||||||
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| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440706325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402745000 | ||||||||
| FaxNumber: | 4407168608 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 WABASH AVE | ||||||||
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| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303447611 | ||||||||
| FaxNumber: | 3303446418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 04/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | SPEAKMAN | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 33033447611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 0206870200 | 01 | FEDERAL BLACK LUNG | OTHER | 0847703 | 05 | OH | MEDICAID | 128075600 | 01 | UNITED DEPARTMENT OF LABOR | OTHER |