MEDICARE: PATHOLOGY ON THE GO INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	800025540	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205169414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHOLOGY ON THE GO INC.

Provider Business Mailing Address
First Line	:	3561 SW 10TH ST
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-4827
Country	:	US
Telephone Number	:	954-977-7959
Fax Number	:	954-977-7962

Provider Business Practice Location Address
First Line	:	3561 SW 10TH ST
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33069-4827
Country	:	US
Telephone Number	:	954-977-7959
Fax Number	:	954-977-7962

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CONSTANCE JEAN CHASTAIN
Credential	:
Telephone Number	:	954-977-7959

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	07/21/2022

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