Organization
PATH MEDICAL, LLC
Active
Other names
Path Medical - MRI Tamarac
Organization subpart
No
Provider details
NPI number
Authorized official
ANICIA O VICENTE MA (BILLING DIRECTOR)
(407) 367-5160
Entity
Organization
Contact information
Practice address
4255 W COMMERCIAL BLVD, TAMARAC, FL 33319-3305
(954) 714-4560
(954) 714-7944
Mailing address
6220 S ORANGE BLOSSOM TRL STE 200, ORLANDO, FL 32809-4678
(407) 367-5160
(407) 730-9928
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
HCC11256
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
475580767
PIP
FL
Enumeration date
01/31/2018
Last updated
06/16/2018
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