1275801789 NPI number — WEST COAST PATHOLOGY OF FLORIDA, PA

Table of content: (NPI 1275801789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275801789 NPI number — WEST COAST PATHOLOGY OF FLORIDA, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COAST PATHOLOGY OF FLORIDA, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275801789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14000 FIVAY RD
Provider Second Line Business Mailing Address:
REGIONAL MEDICAL CENTER, BAYONET POINT
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34667-7103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-819-5252
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14000 FIVAY RD
Provider Second Line Business Practice Location Address:
REGOINAL MEDICAL CENTER, BAYONET POINT
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34667-7103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-819-5252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MOBLEY
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
352-596-6632

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0583111-01 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com