Organization
PATH MEDICAL, LLC
Active
Organization
PATH MEDICAL, LLC
Active
Parent organization
PATH MEDICAL CENTERS HOLDING, INC
Other names
Path Medical - Orange Park
Organization subpart
Yes
Provider details
NPI number
Legal business name
PATH MEDICAL CENTERS HOLDING, INC
Authorized official
ANICIA O VICENTE MA (BILLING DIRECTO)
(407) 367-5160
Entity
Organization
Contact information
Practice address
859 PARK AVE STE 102, ORANGE PARK, FL 32073-4151
(904) 278-7411
(855) 831-2251
Mailing address
6220 S ORANGE BLOSSOM TRL STE 200, ORLANDO, FL 32809-4678
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
HCC11223
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
475580767
PIP
FL
Enumeration date
01/06/2018
Last updated
06/16/2018
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