Basic Information
| Provider Information | |||||||||
| NPI: | 1689652216 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIOPSY DIAGNOSTICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11025 RCA CENTER DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334104269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616265512 | ||||||||
| FaxNumber: | 5616264530 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 RIVERWALK BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | RIDGELAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433792939 | ||||||||
| FaxNumber: | 8433792949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | VALLADARES | ||||||||
| AuthorizedOfficialFirstName: | DINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, CREDENTIALING AND PE | ||||||||
| AuthorizedOfficialTelephone: | 5615145822 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AURORA DIAGNOSTICS, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 14814 | SC | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 052853 | GA | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 00024917 | AL | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 33767 | NC | N | Laboratories | Clinical Medical Laboratory | 291U00000X | PFI8422 | NY | N | Laboratories | Clinical Medical Laboratory | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.