MEDICARE: HAYES PATHOLOGY LABORATORY

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		FL

General Provider Information

NPI Number	:	1639362510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAYES PATHOLOGY LABORATORY

Provider Business Mailing Address
First Line	:	2431 QUANTUM BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8612
Country	:	US
Telephone Number	:	561-752-5550
Fax Number	:	567-752-5549

Provider Business Practice Location Address
First Line	:	2443 QUANTUM BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8612
Country	:	US
Telephone Number	:	561-752-5550
Fax Number	:	561-752-5549

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHAD FREDRICH
Credential	:
Telephone Number	:	561-752-5550

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	08/23/2007

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