Healthcare Provider Details

I. General information

NPI: 1063495489
Provider Name (Legal Business Name): HISTOLOGY TECH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7314 W UNIVERSITY AVE SUITE C
GAINESVILLE FL
32607-1640
US

IV. Provider business mailing address

7314 W UNIVERSITY AVE SUITE C
GAINESVILLE FL
32607-1640
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-0045
  • Fax: 352-331-0028
Mailing address:
  • Phone: 352-331-0045
  • Fax: 352-331-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800020165
License Number StateFL

VIII. Authorized Official

Name: ANDREW J. BROWN
Title or Position: PRESIDENT
Credential:
Phone: 352-331-0045