Provider Demographics
NPI:1932159118
Name:MICRO PATH LABORATORIES INC
Entity Type:Organization
Organization Name:MICRO PATH LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:LARISCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:2006-05-11
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800000683291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030551100Medicaid
FLL8179OtherMEDICARE PTAN