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General NPI Number Information
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NPI Number | 1053754028
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Entity Type | Organization
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Legal Business Name | HEALTHPATH MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 201 NW 82ND AVE STE 203B
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City | PLANTATION
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State | FL
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Zip | 33324-1854
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Country | US
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Telephone | 954-472-7169
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Fax | 954-473-3313
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Provider Business Mailing Address
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Address Line | 201 NW 82ND AVE STE 203B
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City | PLANTATION
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State | FL
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Zip | 33324-1854
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Country | US
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Telephone | 954-472-7169
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Fax | 954-473-3313
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Authorized Official
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Title or Position | DIRECTOR/CEO/PRESIDENT
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Name | MR. ROBERT P. HOSTLER
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Credential |
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Telephone | 703-359-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 23433
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | HCC9758
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License Number State | FL
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