Organization
INDIAN RIVER PATHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY M ROBINSON (REVENUE CYCLE/CREDENTIALING MANAGER)
(770) 490-5009
Entity
Organization
Contact information
Practice address
6696 S US HIGHWAY 1, PORT ST LUCIE, FL 34952-1423
(772) 466-6651
(772) 466-0662
Mailing address
PO BOX 881016, PORT ST LUCIE, FL 34988-1016
(772) 466-6651
(772) 466-0662
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
ME46694
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252482100
—
FL
01
—
41580
BLUECROSS
FL
Enumeration date
03/24/2006
Last updated
01/26/2026
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