Healthcare Provider Details

I. General information

NPI: 1609770726
Provider Name (Legal Business Name): INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 S KANNER HWY
STUART FL
34994-4684
US

IV. Provider business mailing address

PO BOX 741087
ATLANTA GA
30374-1087
US

V. Phone/Fax

Practice location:
  • Phone: 772-807-6303
  • Fax: 772-807-6878
Mailing address:
  • Phone: 772-807-6303
  • Fax: 772-807-5878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL JAMAINE DAVIS
Title or Position: COO
Credential:
Phone: 561-402-4256