Basic Information
| Provider Information | |||||||||
| NPI: | 1023253606 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCUPATH DIAGNOSTIC LABORATORIES INC | ||||||||
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| OtherOrganizationName: | US LAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2240 | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272162240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002227566 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4122 METRIC DR | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327926809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075511600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2008 | ||||||||
| LastUpdateDate: | 12/10/2008 | ||||||||
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| AuthorizedOfficialLastName: | HAYES | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO EVP TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 8002227566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 10D1087553 | 01 | CLIA | OTHER |