Provider Demographics
NPI:1043324767
Name:HUB CARE PATHOLOGY, P.A.
Entity type:Organization
Organization Name:HUB CARE PATHOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-261-2587
Mailing Address - Street 1:5052 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1069
Mailing Address - Country:US
Mailing Address - Phone:601-261-2587
Mailing Address - Fax:601-261-3201
Practice Address - Street 1:5052 W 4TH ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1069
Practice Address - Country:US
Practice Address - Phone:601-261-2587
Practice Address - Fax:601-261-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13985207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014846Medicaid
MS25D0929363OtherCLIA
MSCI2750OtherRAILROAD MEDICARE
MS09014846Medicaid
MS25D0929363OtherCLIA
MSCI2750OtherRAILROAD MEDICARE