Healthcare Provider Details

I. General information

NPI: 1558337212
Provider Name (Legal Business Name): FLORENCE PATHOLOGY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 VETERANS DR
FLORENCE AL
35630-4928
US

IV. Provider business mailing address

PO BOX 1179
FLORENCE AL
35631-1179
US

V. Phone/Fax

Practice location:
  • Phone: 256-629-1825
  • Fax:
Mailing address:
  • Phone: 256-629-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number00015292
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: STEVEN DOUGLAS WHITE
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 256-629-1825