MEDICARE: ADVANCED PATHOLOGY OF PALM BEACH COUNTY, PA

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

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

General Provider Information

NPI Number	:	1235462904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PATHOLOGY OF PALM BEACH COUNTY, PA

Provider Business Mailing Address
First Line	:	5065 STATE ROAD 7
Second Line	:	SUITE 202
City	:	LAKE WORTH
State	:	FL
Zip	:	33449-4615
Country	:	US
Telephone Number	:	561-273-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	5065 STATE ROAD 7
Second Line	:	SUITE 202
City	:	LAKE WORTH
State	:	FL
Zip	:	33449-4615
Country	:	US
Telephone Number	:	561-273-2340
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MADELEINE TALBOTT
Credential	:	RN
Telephone Number	:	561-273-2340

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	06/28/2011

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