Basic Information
| Provider Information | |||||||||
| NPI: | 1609107325 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABC PATH LAB CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 SW 148TH AVE | ||||||||
| Address2: | SUITE 250B | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330274169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548855551 | ||||||||
| FaxNumber: | 9548855559 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 SW 148TH AVENUE | ||||||||
| Address2: | SUITE 250B | ||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548855551 | ||||||||
| FaxNumber: | 9548855559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 01/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | FLORES | ||||||||
| AuthorizedOfficialFirstName: | FRANCISCO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9548855551 | ||||||||
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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 | 291U00000X | ME72663 | FL | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.