Healthcare Provider Details

I. General information

NPI: 1457320194
Provider Name (Legal Business Name): ACCUPATH PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5938 FROND WAY
APOLLO BEACH FL
33572
US

IV. Provider business mailing address

5938 FROND WAY
APOLLO BEACH FL
33572-2646
US

V. Phone/Fax

Practice location:
  • Phone: 813-641-0484
  • Fax: 813-641-0488
Mailing address:
  • Phone: 813-641-0484
  • Fax: 813-641-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number800001365
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800001365
License Number StateFL

VIII. Authorized Official

Name: DR. RUSSELL H WONG
Title or Position: MEDICAL DIRECTOR MD
Credential: MD
Phone: 813-641-0484