Organization
PHOENIX MEDICAL LABORATORY
Active
Parent organization
NEOGENOMICS, INC
Other names
Path Lab Fort Myers
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEOGENOMICS, INC
Authorized official
MR. ROBERT P GASPARINI (PRESIDENT)
(239) 768-0600
Entity
Organization
Contact information
Practice address
12701 COMMONWEALTH DR, SUITE 6, FORT MYERS, FL 33913-8626
(239) 768-0600
(239) 768-0711
Mailing address
12701 COMMONWEALTH DR, SUITE 6, FORT MYERS, FL 33913-8626
(239) 768-0600
(239) 768-0711
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
8000017185
FL
291U00000X
Clinical Medical Laboratory
Primary
8000019289
FL
291U00000X
Clinical Medical Laboratory
CLIA10D1023653
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L9266
BCBS FL
FL
Enumeration date
10/21/2005
Last updated
05/29/2008
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