Provider Demographics
NPI:1225588692
Name:PATH MEDICAL ACQUISITION COMPANY INC
Entity Type:Organization
Organization Name:PATH MEDICAL ACQUISITION COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-347-1670
Mailing Address - Street 1:2304 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1422
Mailing Address - Country:US
Mailing Address - Phone:954-735-6584
Mailing Address - Fax:954-337-3965
Practice Address - Street 1:1380 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4719
Practice Address - Country:US
Practice Address - Phone:954-735-6584
Practice Address - Fax:954-337-3965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC5435261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation