Organization
HISTOPATH LAB, PA- GENOMICS
Active
Parent organization
HISTOPATH LAB, P.A.
Organization subpart
Yes
Provider details
NPI number
Legal business name
HISTOPATH LAB, P.A.
Authorized official
MRS. PATRICIA WARE ALEXANDER (VICE PRESIDENT)
(352) 527-1344
Entity
Organization
Contact information
Practice address
2671 W NORVELL BRYANT HWY, LECANTO, FL 34461-9440
(352) 527-1344
(352) 527-2259
Mailing address
2671 W NORVELL BRYANT HWY, LECANTO, FL 34461-9440
(352) 527-1344
(352) 527-2259
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800001816
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009504100
—
FL
01
—
1518392653
NPI
FL
Enumeration date
09/09/2013
Last updated
08/04/2014
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