Organization
SPACE COAST PATHOLOGISTS PA
Active
Parent organization
SPACE COAST PATHOLOGISTS PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPACE COAST PATHOLOGISTS PA
Authorized official
CARL T. SMEDBERG M.D. (PRESIDENT)
(321) 953-4804
Entity
Organization
Contact information
Practice address
13695 US HIGHWAY 1, SEBASTIAN, FL 32958-3230
(772) 589-3186
(772) 589-1022
Mailing address
PO BOX 144333, ORLANDO, FL 32814-4333
(407) 422-9831
(407) 648-2065
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C15028
RAILROAD MEDICARE
—
Enumeration date
02/28/2008
Last updated
02/28/2008
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