Provider Demographics
NPI:1912290248
Name:MANATEE PATHOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:MANATEE PATHOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-665-4614
Mailing Address - Street 1:1500 SAN REMO AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3043
Mailing Address - Country:US
Mailing Address - Phone:305-666-2427
Mailing Address - Fax:305-666-1065
Practice Address - Street 1:8330 LAKEWOOD RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5174
Practice Address - Country:US
Practice Address - Phone:305-666-2427
Practice Address - Fax:305-666-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31656207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273956901Medicaid