Organization
SURGICAL PATHOLOGY LABORATORIES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY J BULSON D.O. (PRESIDENT)
(727) 545-2339
Entity
Organization
Contact information
Practice address
8455 66TH ST, PINELLAS PARK, FL 33781-1206
(727) 545-2339
(727) 545-1644
Mailing address
8455 66TH ST N, PINELLAS PARK, FL 33781-1206
(727) 548-7732
(727) 545-1644
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800014408
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220025650
RR MEDICARE
FL
05
—
277272800
—
FL
01
—
80591
BCBS
FL
01
—
L9274
BCBS
FL
Enumeration date
02/15/2006
Last updated
06/15/2010
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