Healthcare Provider Details

I. General information

NPI: 1942526298
Provider Name (Legal Business Name): INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE C/O JFK MEDICAL CENTER LABORATORY
ATLANTIS FL
33462-1149
US

IV. Provider business mailing address

PO BOX 741087
ATLANTA GA
30374-1087
US

V. Phone/Fax

Practice location:
  • Phone: 954-777-0018
  • Fax: 954-777-3440
Mailing address:
  • Phone: 954-507-6780
  • Fax: 866-262-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN HABER
Title or Position: VP OPERATIONS
Credential:
Phone: 954-767-5797