Organization
PATH MEDICAL, LLC
Active
Parent organization
PATH MEDICAL CENTER HOLDINGS, INC
Other names
Path Medical - Northside, Path Medical- Arlington
Organization subpart
Yes
Provider details
NPI number
Legal business name
PATH MEDICAL CENTER HOLDINGS, INC
Authorized official
ANICIA O VICENTE MA (DIRECTOR OF BILLING)
(407) 367-5166
Entity
Organization
Contact information
Practice address
9119 MERRILL RD STE 32, JACKSONVILLE, FL 32225-4306
(904) 575-3695
(855) 831-2252
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
HCC11220
FL
261QH0100X
Health Service Clinic/Center
Primary
HCC11222
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
475580767
PIP
FL
Enumeration date
01/06/2018
Last updated
06/16/2018
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