Provider Demographics
NPI:1417007386
Name:BENCHMARK PATHOLOGY LABORATORY
Entity Type:Organization
Organization Name:BENCHMARK PATHOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEAPHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-721-2400
Mailing Address - Street 1:600 VILLAGE SQUARE XING
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4543
Mailing Address - Country:US
Mailing Address - Phone:561-721-2400
Mailing Address - Fax:561-721-1249
Practice Address - Street 1:600 VILLAGE SQUARE XING
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4543
Practice Address - Country:US
Practice Address - Phone:561-721-2400
Practice Address - Fax:561-721-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE9173Medicare ID - Type Unspecified