NPIMap

Organization Active NPI

Path Medical, LLC

  • Clinic/Center
  • Tampa, FL
National Provider Identifier
1801332697
Registry record updated Nov 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PATH MEDICAL, LLC
Practice address
3117 W Columbus Dr Ste 209
Tampa, FL 33607-1855
Phone
(407) 367-5160
Fax
(407) 730-9928
NPI assigned
Jan 17, 2017
Organization subpart
Yes
Parent organization
PATH MEDICAL CENTER HOLDINGS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2019

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

Authorized official

Name
Dr. Neil Bonnardel, MD
Title
Director of Medical Services
Phone
(754) 218-2164

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X

Addresses

Primary practice location

3117 W Columbus Dr Ste 209
Tampa, FL 33607-1855

Mailing address

2304 W Oakland Park Blvd
Oakland Park, FL 33311-1422
Phone (754) 218-2164

Other identifiers 1

IdentifierTypeStateIssuer
HCC9731OtherFLSTATE LICENSE

Other names 2

  • Path Medical - Absolute Doing business as
  • Path Medical- ACI Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Path Medical LLC24 organizations share this tax ID, including this one
Part of
Path Medical LLC

Other organizations with this tax ID 23

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

View all 23

Locations

3117 W Columbus Dr
Ste 209
Tampa, FL 33607
Phone (407) 367-5160

NPI Registry JSON

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572998400000",
    "number": "1801332697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 W OAKLAND PARK BLVD",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333111422",
            "telephone_number": "754-218-2164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3117 W COLUMBUS DR STE 209",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336071855",
            "telephone_number": "407-367-5160",
            "fax_number": "407-730-9928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATH MEDICAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATH MEDICAL CENTER HOLDINGS, INC.",
        "enumeration_date": "2017-01-17",
        "last_updated": "2019-11-06",
        "status": "A",
        "authorized_official_last_name": "BONNARDEL",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "DIRECTOR OF MEDICAL SERVICES",
        "authorized_official_telephone_number": "754-218-2164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "HCC9731",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Path Medical - Absolute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Path Medical - Absolute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Path Medical- ACI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; 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.