Provider Demographics
NPI:1649220872
Name:LAKELAND PATHOLOGISTS, PA
Entity Type:Organization
Organization Name:LAKELAND PATHOLOGISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-683-7171
Mailing Address - Street 1:1125 BARTOW RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5852
Mailing Address - Country:US
Mailing Address - Phone:863-683-7171
Mailing Address - Fax:863-687-0742
Practice Address - Street 1:1125 BARTOW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5852
Practice Address - Country:US
Practice Address - Phone:863-683-7171
Practice Address - Fax:863-687-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008316300Medicaid
FL008316300Medicaid