MEDICARE: ACCUPATH DIAGNOSTIC LABORATORIES, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D2306747	OTHER		CLIA

General Provider Information

NPI Number	:	1710723846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCUPATH DIAGNOSTIC LABORATORIES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2240
Second Line	:
City	:	BURLINGTON
State	:	NC
Zip	:	27216-2240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1046 BONNER AVE
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94536-4006
Country	:	US
Telephone Number	:	555-555-5555
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	KIMBERLY T WILLIAMS
Credential	:
Telephone Number	:	336-436-5402

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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