Provider Demographics
NPI:1164523478
Name:HEMATOPATHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:HEMATOPATHOLOGY ASSOCIATES LLC
Other - Org Name:BIO-GENETICS LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-201-1890
Mailing Address - Street 1:805 EXECUTIVE CENTER DR W STE 300
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2407
Mailing Address - Country:US
Mailing Address - Phone:727-201-1890
Mailing Address - Fax:727-275-1975
Practice Address - Street 1:805 EXECUTIVE CENTER DR W STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2407
Practice Address - Country:US
Practice Address - Phone:727-201-1890
Practice Address - Fax:727-275-1975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEMATOPATHOLOGY ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800017597291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE9101Medicare ID - Type Unspecified