Provider Demographics
NPI:1639362510
Name:HAYES PATHOLOGY LABORATORY
Entity Type:Organization
Organization Name:HAYES PATHOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-752-5550
Mailing Address - Street 1:2431 QUANTUM BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8612
Mailing Address - Country:US
Mailing Address - Phone:561-752-5550
Mailing Address - Fax:567-752-5549
Practice Address - Street 1:2443 QUANTUM BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8612
Practice Address - Country:US
Practice Address - Phone:561-752-5550
Practice Address - Fax:561-752-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory