MEDICARE: FLOW PATH LABORATORIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	10D1061166	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	99799	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1073610275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOW PATH LABORATORIES INC

Provider Business Mailing Address
First Line	:	PO BOX 63069
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29419-3069
Country	:	US
Telephone Number	:	866-759-4528
Fax Number	:

Provider Business Practice Location Address
First Line	:	7449 SOUTH MILITARY TRAIL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463
Country	:	US
Telephone Number	:	305-229-4311
Fax Number	:	305-229-4388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LARRY S HIRSCHFIELD
Credential	:	MD
Telephone Number	:	561-491-8035

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/07/2011

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