Provider Demographics
NPI:1457320194
Name:ACCUPATH PLUS LLC
Entity Type:Organization
Organization Name:ACCUPATH PLUS LLC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:H
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-641-0484
Mailing Address - Street 1:5938 FROND WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2646
Mailing Address - Country:US
Mailing Address - Phone:813-641-0484
Mailing Address - Fax:813-641-0488
Practice Address - Street 1:5938 FROND WAY
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572
Practice Address - Country:US
Practice Address - Phone:813-641-0484
Practice Address - Fax:813-641-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800001365207ZP0101X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty