Provider Demographics
NPI:1942526298
Name:INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
Entity Type:Organization
Organization Name:INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
Other - Org Name:IRL PATHOLOGY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-767-5797
Mailing Address - Street 1:PO BOX 741087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1087
Mailing Address - Country:US
Mailing Address - Phone:954-507-6780
Mailing Address - Fax:866-262-5507
Practice Address - Street 1:5301 S CONGRESS AVE
Practice Address - Street 2:C/O JFK MEDICAL CENTER LABORATORY
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1149
Practice Address - Country:US
Practice Address - Phone:954-777-0018
Practice Address - Fax:954-777-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty