QUANTUM HOSPITAL PATHOLOGY, LLC - NPI NUMBER 1679829816

Summary

Provider Name: QUANTUM HOSPITAL PATHOLOGY, LLC

NPI Number: 1679829816

Clasification: Pathology (207ZP0102X)

Specialization: Anatomic Pathology & Clinical Pathology

Address:
151 E REDSTONE AVE
CRESTVIEW, FL
ZIP 32539

Phone Number: (850) 689-8100



Detailed Information

QUANTUM HOSPITAL PATHOLOGY, LLC is an anatomic & clinical pathologist in Crestview, FL. The provider is a pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. The assigned NPI number for this provider is 1679829816 and is registered as an organization entity type and is a single specialty group.

The provider's business address is:

151 E REDSTONE AVE
CRESTVIEW, FL
ZIP 32539-352
Phone: (850) 689-8100
Fax: (419) 866-5453

The provider's authorized official is North Davis .
The authorized official title is President and has the following contact phone number (850) 689-8100.

The enumeration date for this NPI number is 7/25/2012 and was last updated on 9/24/2014.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1679829816 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name QUANTUM HOSPITAL PATHOLOGY, LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 151 E REDSTONE AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name CRESTVIEW The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name FL The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 325395352 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 8506898100 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 4198665453 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 7/25/2012 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 9/24/2014 The date that a record was last updated or changed.
14 Authorized Official Last Name DAVIS The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name NORTH The first name of the authorized official.
16 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
17 Authorized Official Telephone Number 8506898100 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 207ZP0102X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Is Organization Subpart N
21 Authorized Official Credential Text MD
22 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

Similar Providers Nearby

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1972931954 DR. JODY LYNN NIELSEN, MD Individual Pathology (Forensic Pathology)


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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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