Provider Demographics
NPI:1548420672
Name:VILLAGES PATHOLOGY LABORATORY LLC
Entity Type:Organization
Organization Name:VILLAGES PATHOLOGY LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LALBAHADUR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGABHAIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-307-0264
Mailing Address - Street 1:10900 SE 174TH PLACE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10900 SE 174TH PLACE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8984
Practice Address - Country:US
Practice Address - Phone:352-307-0264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D1080337291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory