Basic Information
| Provider Information | |||||||||
| NPI: | 1265465801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUISVILLE PATHOLOGY ASSOCIATES PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 SOUTHWYCK BLVD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436141509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002888325 | ||||||||
| FaxNumber: | 4198665453 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 ABRAHAM FLEXNER WAY | ||||||||
| Address2: | PATHOLOGY DEPT | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024566212 | ||||||||
| FaxNumber: | 5024564440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | TISONE | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | LABORATORY MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5024566212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZB0001X | KY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | 207ZC0500X | KY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZH0000X | KY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207ZP0102X | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 7100237730 | 05 | KY | MEDICAID | 0781049-01 | 01 | TX | MEDICAID TEXAS | OTHER | 206644601 | 01 | MO | MEDICAID MISSOURI | OTHER | 290445 | 01 | BLACK LUNG PROGRAM | OTHER | 912684800 | 01 | FL | MEDICAID FLORIDA | OTHER | CF7906 | 01 | RAILROAD MEDICARE | OTHER | 0956501 | 01 | CIGNA HEALTHCARE | OTHER | 100009590A | 01 | IN | MEDICAID INDIANA | OTHER | 1050655 | 01 | KY | PASSPORT MEDICAID | OTHER | 1301279 | 01 | UNITED MINE WORKERS | OTHER | 4281366 | 01 | TN | MEDICAID TENNESSEE | OTHER | 9114175 | 01 | CO | MEDICAID COLORADO | OTHER | 144621 | 01 | NV | WORKERS COMP NEVADA | OTHER | 163417200 | 01 | FL | WORKERS COMP FLORIDA | OTHER | 6602886 | 01 | VA | MEDICAID VIRGINIA | OTHER | 000000058947 | 01 | KY | ANTHEM BLUE CROSS BS | OTHER | 1100338 | 01 | UNITED HEALTHCARE | OTHER |