NPIMap

Organization Active NPI

Path Medical, LLC

  • Health Service Clinic/Center
  • Jacksonville, FL
National Provider Identifier
1972010346
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
HCC11222 Issued in FL
Legal business name
PATH MEDICAL, LLC
Practice address
9119 Merrill Rd Ste 32
Jacksonville, FL 32225-4306
Phone
(904) 575-3695
Fax
(855) 831-2252
NPI assigned
Jan 6, 2018
Organization subpart
Yes
Parent organization
PATH MEDICAL CENTER HOLDINGS, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Anicia O Vicente, MA
Title
Director of Billing
Phone
(407) 367-5166

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X HCC11220 FL
Health Service Clinic/Center 261QH0100X HCC11222 FL Primary

Addresses

Primary practice location

9119 Merrill Rd Ste 32
Jacksonville, FL 32225-4306

Mailing address

6220 S Orange Blossom TRL Ste 200
Orlando, FL 32809-4678
Phone (407) 367-5160

Other practice location 1

2386 Dunn Ave Ste 109
Jacksonville, FL 32218-4751
Phone (904) 854-2147

Other identifiers 1

IdentifierTypeStateIssuer
475580767OtherFLPIP

Other names 2

  • Path Medical - Northside Doing business as
  • Path Medical- Arlington Doing business as

National Provider Directory

National Provider Directory
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.

Locations

9119 Merrill Rd
Ste 32
Jacksonville, FL 32225
Phone (800) 332-7262

NPI Registry JSON

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": "1972010346",
    "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",
            "telephone_number": "407-367-5160",
            "fax_number": "407-730-9928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9119 MERRILL RD STE 32",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322254306",
            "telephone_number": "904-575-3695",
            "fax_number": "855-831-2252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2386 Dunn Ave Ste 109",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322184751",
            "country_code": "US",
            "telephone_number": "904-854-2147",
            "fax_number": "904-619-8271",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATH MEDICAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATH MEDICAL CENTER HOLDINGS, 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": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "407-367-5166",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "HCC11220",
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "FL",
            "license": "HCC11222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PIP",
            "identifier": "475580767",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Path Medical - Northside",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Path Medical- Arlington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

  • 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.