Basic Information
| Provider Information | |||||||||
| NPI: | 1134190564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLOBAL PATHOLOGY LABORATORY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16250 NW 59TH AVE | ||||||||
| Address2: | #201 | ||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330147542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058254422 | ||||||||
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| Address1: | 16250 NW 59TH AVE | ||||||||
| Address2: | #201 | ||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330147542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058254422 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 05/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | HANLY | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3058254422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 220030013 | 01 | FL | RAILROAD MEDICARE | OTHER | CH5809 | 01 | FL | RAILROAD MEDICARE | OTHER |