Provider Demographics
NPI:1821192147
Name:FIRSTPATH PA
Entity Type:Organization
Organization Name:FIRSTPATH PA
Other - Org Name:NORTH RIDGE PATHOLOGY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GIFFLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-665-4614
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-0890
Mailing Address - Country:US
Mailing Address - Phone:304-323-4320
Mailing Address - Fax:
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE 404
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-771-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260369100Medicaid
FL45498OtherBCBS OF FLORIDA
FL45498Medicare PIN