Organization
MICRO PATH LABORATORIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG D LARISCY M.D. (PRESIDENT)
(863) 683-7171
Entity
Organization
Contact information
Practice address
1125 BARTOW RD, SUITE 101, LAKELAND, FL 33801-5852
(863) 683-7171
(863) 687-0742
Mailing address
1125 BARTOW RD, SUITE 101, LAKELAND, FL 33801-5852
(863) 683-7171
(863) 687-0742
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800000683
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030551100
—
FL
01
—
L8179
MEDICARE PTAN
FL
Enumeration date
05/11/2006
Last updated
02/02/2016
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