Basic Information
| Provider Information | |||||||||
| NPI: | 1639151442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLEGIANT PATHOLOGISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 144333 | ||||||||
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| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328144333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074229831 | ||||||||
| FaxNumber: | 4076482065 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 1ST CAPITOL DR | ||||||||
| Address2: | DEPT. OF PATHOLOGY | ||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633012844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369475420 | ||||||||
| FaxNumber: | 6369475257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | LOMBARDO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6369475420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 505046409 | 05 | MO | MEDICAID | CH0439 | 01 | RAILROAD MEDICARE | OTHER |