Provider Demographics
NPI:1558616870
Name:PHYSICIAN'S PATHOLOGY SERVICES, PA
Entity Type:Organization
Organization Name:PHYSICIAN'S PATHOLOGY SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-702-8027
Mailing Address - Street 1:5519 AVENUE DU SOLEIL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2835
Mailing Address - Country:US
Mailing Address - Phone:407-702-8027
Mailing Address - Fax:813-949-8427
Practice Address - Street 1:451 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5418
Practice Address - Country:US
Practice Address - Phone:407-702-8027
Practice Address - Fax:813-949-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2030221291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory