MEDICARE: AMERICAN DERMPATH SPECIALISTS 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	10D1023742	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L9279	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1619080009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN DERMPATH SPECIALISTS INC

Provider Business Mailing Address
First Line	:	8130 ROYAL PALM BLVD
Second Line	:	SUITE 201
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5703
Country	:	US
Telephone Number	:	954-232-9479
Fax Number	:	954-421-3201

Provider Business Practice Location Address
First Line	:	8130 ROYAL PALM BLVD
Second Line	:	SUITE 201
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5703
Country	:	US
Telephone Number	:	954-232-9479
Fax Number	:	954-421-3201

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MICHELLE SCHLECKER
Credential	:
Telephone Number	:	954-421-3200

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	11/14/2008

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