Provider Demographics
NPI:1558337212
Name:FLORENCE PATHOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:FLORENCE PATHOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-629-1825
Mailing Address - Street 1:PO BOX 1179
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-1179
Mailing Address - Country:US
Mailing Address - Phone:256-629-1825
Mailing Address - Fax:
Practice Address - Street 1:1701 VETERANS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4928
Practice Address - Country:US
Practice Address - Phone:256-629-1825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015292207ZP0102X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1369527Medicaid
MS00878878Medicaid
AL528601070Medicaid
AL051557652Medicaid
MS04832896Medicaid
TN4490750Medicaid
MS04832896Medicaid
AL051557652Medicaid