# INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013764786
- **Authorized official:** MICHAEL JAMAINE DAVIS (COO)
- **Authorized official phone:** (561) 402-4256

## Contact information

- **Practice address:** 524 W SAGAMORE AVE, CLEWISTON, FL 33440-3514
- **Practice address phone:** (954) 507-6780
- **Mailing address:** PO BOX 741087, ATLANTA, GA 30374-1087

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2024
- **Last updated:** 05/01/2024