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General NPI Number Information
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NPI Number | 1720103013
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Entity Type | Organization
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Legal Business Name | US PATH LABS LLC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 902 CLINT MOORE RD SUITE 222
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City | BOCA RATON
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State | FL
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Zip | 33487-2800
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Country | US
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Telephone | 561-989-0027
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Fax | 561-989-0052
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Provider Business Mailing Address
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Address Line | 902 CLINT MOORE RD SUITE 222
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City | BOCA RATON
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State | FL
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Zip | 33487-2800
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Country | US
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Telephone | 561-989-0027
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Fax | 561-989-0052
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Authorized Official
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Title or Position | MGR
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Name | MR. ANDREW QUEEN
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Credential |
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Telephone | 561-989-0027
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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 | 800019305
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License Number State | FL
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