Provider Demographics
NPI: | 1497207559 |
---|---|
Name: | PATHOLOGY ASSOCIATES OF NORTH FLORIDA |
Entity Type: | Organization |
Organization Name: | PATHOLOGY ASSOCIATES OF NORTH FLORIDA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CO-OWER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RIZWANA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | THANAWALA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 386-758-6094 |
Mailing Address - Street 1: | 4355 NW AMERICAN LN |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKE CITY |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32055-4828 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 386-758-6094 |
Mailing Address - Fax: | 386-758-6995 |
Practice Address - Street 1: | 4355 NW AMERICAN LN |
Practice Address - Street 2: | |
Practice Address - City: | LAKE CITY |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32055-4828 |
Practice Address - Country: | US |
Practice Address - Phone: | 386-758-6094 |
Practice Address - Fax: | 386-758-6995 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-25 |
Last Update Date: | 2017-03-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 800027822 | 291U00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 291U00000X | Laboratories | Clinical Medical Laboratory |