=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821510710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HISTOLOGY SOLUTIONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1620 MEDICAL LN STE 120
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-1143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-939-4604
-----------------------------------------------------
Fax | 239-939-4604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1620 MEDICAL LN STE 120
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-1143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-939-4604
-----------------------------------------------------
Fax | 239-939-4604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | GEORGE C KALEMERIS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-565-3004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZC0006X
-----------------------------------------------------
Taxonomy Name | Clinical Pathology Physician
-----------------------------------------------------
License Number | 800028271
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------