Provider Demographics
NPI:1548274897
Name:RELIANCE PATHOLOGY PARTNERS, LLC
Entity type:Organization
Organization Name:RELIANCE PATHOLOGY PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-886-8334
Mailing Address - Street 1:5747 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5340
Mailing Address - Country:US
Mailing Address - Phone:813-886-8334
Mailing Address - Fax:813-890-0143
Practice Address - Street 1:5747 HOOVER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5340
Practice Address - Country:US
Practice Address - Phone:813-886-8334
Practice Address - Fax:813-890-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800018934291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030761100Medicaid
FL030761100Medicaid