Provider Demographics
NPI:1275801789
Name:WEST COAST PATHOLOGY OF FLORIDA, PA
Entity Type:Organization
Organization Name:WEST COAST PATHOLOGY OF FLORIDA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-596-6632
Mailing Address - Street 1:14000 FIVAY RD
Mailing Address - Street 2:REGIONAL MEDICAL CENTER, BAYONET POINT
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7103
Mailing Address - Country:US
Mailing Address - Phone:727-819-5252
Mailing Address - Fax:
Practice Address - Street 1:14000 FIVAY RD
Practice Address - Street 2:REGOINAL MEDICAL CENTER, BAYONET POINT
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7103
Practice Address - Country:US
Practice Address - Phone:727-819-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0583111-01Medicaid
FL0583111-01Medicaid