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NPI Code Detail

MEDICARE: INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC

MEDICARE: INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427624493
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC
Provider Business Mailing Address
First Line : PO BOX 741087
Second Line :
City : ATLANTA
State : GA
Zip : 30374-1087
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3157 N MONROE ST
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32303-2819
Country : US
Telephone Number : 850-325-5888
Fax Number :
Authorized Official
Title or Position : OWNER/VP OF OPERATIONS
Name : JOHN RODKEY
Credential :
Telephone Number : 850-523-2117
Provider Enumeration Date : 06/01/2021
Last Update Date : 06/01/2021

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Directions to “INTEGRATED REGIONAL LABORATORIES PATHOLOGY SERVICES, LLC ” Practice Location

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