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General NPI Number Information
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NPI Number | 1609770726
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Entity Type | Organization
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Legal Business Name | INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 10/03/2026
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Last Update Date | 10/03/2026
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Provider Practice Location Address
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Address Line | 2551 S KANNER HWY
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City | STUART
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State | FL
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Zip | 34994-4684
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Country | US
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Telephone | 772-807-6303
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Fax | 772-807-6878
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Provider Business Mailing Address
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Address Line | PO BOX 741087
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City | ATLANTA
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State | GA
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Zip | 30374-1087
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Country | US
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Telephone | 772-807-6303
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Fax | 772-807-5878
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Authorized Official
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Title or Position | COO
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Name | MICHAEL JAMAINE DAVIS
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Credential |
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Telephone | 561-402-4256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State | NULL
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