Provider Demographics
NPI:1063495489
Name:HISTOLOGY TECH SERVICES INC
Entity Type:Organization
Organization Name:HISTOLOGY TECH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-331-0045
Mailing Address - Street 1:7314 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1640
Mailing Address - Country:US
Mailing Address - Phone:352-331-0045
Mailing Address - Fax:352-331-0028
Practice Address - Street 1:7314 W UNIVERSITY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1640
Practice Address - Country:US
Practice Address - Phone:352-331-0045
Practice Address - Fax:352-331-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800020165291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE9170AOtherMEDICARE - PART B
FLL9288OtherBC BS OF FLORIDA
FLL9288OtherBC BS OF FLORIDA