Provider Demographics
NPI:1518356286
Name:PATRIOT MEDICAL SERVICES
Entity Type:Organization
Organization Name:PATRIOT MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-255-4560
Mailing Address - Street 1:1730 S FEDERAL HWY
Mailing Address - Street 2:#289
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3715
Practice Address - Country:US
Practice Address - Phone:561-255-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
FLOS9035251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty