Provider Demographics
NPI:1801224274
Name:FLOYD PATHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:FLOYD PATHOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-456-6211
Mailing Address - Street 1:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47151-1286
Mailing Address - Country:US
Mailing Address - Phone:502-456-6211
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:502-456-6211
Practice Address - Fax:502-456-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100116000AMedicaid
KY50062355OtherPASSPORT
KY7100275520Medicaid
KY000000854058OtherANTHEM
INDU5009OtherMEDICARE RR
INDU5009OtherMEDICARE RR