Organization
SPACE COAST PATHOLOGISTS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL T. SMEDBERG M.D. (PRESIDENT)
(321) 953-4804
Entity
Organization
Contact information
Practice address
1350 S HICKORY ST, DEPT. OF PATHOLOGY, MELBOURNE, FL 32901-3278
(321) 434-7000
(321) 434-5295
Mailing address
PO BOX 144333, ORLANDO, FL 32814-4333
(407) 422-9831
(407) 648-2065
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054991600
—
FL
Enumeration date
11/16/2005
Last updated
02/13/2008
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