=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427911445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2339 GULF TO BAY BLVD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33765-4102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-588-5812
-----------------------------------------------------
Fax | 727-588-5911
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 741087
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-1087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-588-5812
-----------------------------------------------------
Fax | 727-588-5911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MICHAEL JAMAINE DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-402-4256
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------