Provider Demographics
NPI:1447941174
Name:NORTHWEST PATHOLOGY PS
Entity type:Organization
Organization Name:NORTHWEST PATHOLOGY PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLGAMOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-734-2800
Mailing Address - Street 1:3560 MERIDIAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S 12TH ST STE D
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4000
Practice Address - Country:US
Practice Address - Phone:877-232-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST PATHOLOGY, PS DBA AVERO DIAGNOSTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-15
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory