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General NPI Number Information
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NPI Number | 1245704451
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Entity Type | Organization
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Legal Business Name | PATHEMA GX, LLC
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 20 S FEDERAL HWY # A
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City | DANIA
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State | FL
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Zip | 33004-3605
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Country | US
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Telephone | 754-702-7168
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Fax |
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Provider Business Mailing Address
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Address Line | 20 S FEDERAL HWY # A
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City | DANIA
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State | FL
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Zip | 33004-3605
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Country | US
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Telephone | 754-702-7168
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHRISTOPHER TODD EAVES
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Credential |
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Telephone | 916-716-7117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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