Healthcare Provider Details

I. General information

NPI: 1639432875
Provider Name (Legal Business Name): UNIVERSITY OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD UF DEPARTMENT OF PATHOLOGY
GAINESVILLE FL
32610-0275
US

IV. Provider business mailing address

1600 SW ARCHER RD UF DEPARTMENT OF PATHOLOGY
GAINESVILLE FL
32610-0275
US

V. Phone/Fax

Practice location:
  • Phone: 443-629-9410
  • Fax:
Mailing address:
  • Phone: 443-629-9410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberTRN17429
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberTRN17429
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberTRN17429
License Number StateFL

VIII. Authorized Official

Name: DONNA FAY BALKCOM
Title or Position: OFFICE ASSISTANT
Credential:
Phone: 352-265-0680