1518073584 NPI number — PASCO PATHOLOGY SERVICES, INC.

Table of content: (NPI 1518073584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518073584 NPI number — PASCO PATHOLOGY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASCO PATHOLOGY SERVICES, INC.
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:
1518073584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100559
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29502-0559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-664-4300
Provider Business Mailing Address Fax Number:
843-664-4308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 MADISON STREET
Provider Second Line Business Practice Location Address:
PASCO PATHOLOGY SERVICES INC
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-841-4687
Provider Business Practice Location Address Fax Number:
770-776-5966
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ONG
Authorized Official First Name:
YAO CHENG
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-841-4687

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  10D0297904 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 74971 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 271717400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051285100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74971 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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