Path Medical, LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

HCC11223 Issued in FL

Legal business name

PATH MEDICAL, LLC

Doing business as

Path Medical - Orange Park

Practice address

859 Park Ave Ste 102
Orange Park, FL 32073-4151

Phone

(904) 278-7411

Fax

(855) 831-2251

NPI assigned

Jan 6, 2018

Last updated

Jun 16, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

PATH MEDICAL CENTERS HOLDING, INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anicia O Vicente, MA

Title

Billing Directo

Phone

(407) 367-5160

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Path Medical - Orange Park Doing business as

Tax ID family

Path Medical LLC6 organizations share this tax ID, including this one

Part of

Path Medical LLC

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

• Path Medical, LLC

  dba Path Medical - Arlington

  • Health Service Clinic/Center
  • Orange Park, FL
  • NPI 1275031569
  NPD tax ID
• Path Medical, LLC

  dba Path Medical - Pompano

  • Health Service Clinic/Center
  • Pompano Beach, FL
  • NPI 1407358476
  NPD tax ID
• Path Medical, LLC

  dba Path Medical - MRI Tamarac

  • Health Service Clinic/Center
  • Tamarac, FL
  • NPI 1588162838
  NPD tax ID
• Path Medical, LLC

  dba Path Medical -MRI Boca

  • Health Service Clinic/Center
  • Boca Raton, FL
  • NPI 1922500545
  NPD tax ID
• Path Medical, LLC

  dba Path Medical - Northside

  • Health Service Clinic/Center
  • Jacksonville, FL
  • NPI 1972010346
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1515196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1316454788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6220 S ORANGE BLOSSOM TRL STE 200",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328094678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 PARK AVE STE 102",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734151",
            "telephone_number": "904-278-7411",
            "fax_number": "855-831-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATH MEDICAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATH MEDICAL CENTERS HOLDING, INC",
        "enumeration_date": "2018-01-06",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "VICENTE",
        "authorized_official_first_name": "ANICIA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "BILLING DIRECTO",
        "authorized_official_telephone_number": "407-367-5160",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "HCC11223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PIP",
            "identifier": "475580767",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Path Medical - Orange Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ronak Jayesh Patel
• Sagar S Patel
• Tehmina Patel, MD
• Tristan Tushar Patel
• Path Medical, LLC (Path Medical - Arlington)
• Pathways Resolution Center, Inc. (OMS, Inc.)
• Desiree Patrick, LMHC
• Laelisha Patton, ARNP
• Michael Joseph Paulk, D.C.
• Charity Payne, ATC

• Health Service Clinic/Center in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Health Service Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.