Organization
PATH MEDICAL, LLC
Active
Parent organization
PATH MEDICAL
Other names
Path Medical - Central Tampa
Organization subpart
Yes
Provider details
NPI number
Legal business name
PATH MEDICAL
Authorized official
ANICIA O VICENTE (BILLING DIRECTOR)
(407) 399-9070
Entity
Organization
Contact information
Practice address
4700 N HABANA AVE STE 100, TAMPA, FL 33614-7116
(813) 549-1515
(813) 549-1516
Mailing address
4700 N HABANA AVE STE 100, TAMPA, FL 33614-7116
(813) 549-1515
(813) 549-1516
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
HCC8645
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
475580767
PIP
FL
Enumeration date
03/09/2017
Last updated
03/09/2017
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