Provider Demographics
NPI:1205895844
Name:BOCA PATHOLOGY INC
Entity type:Organization
Organization Name:BOCA PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-955-4136
Mailing Address - Street 1:PO BOX 63069
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:305-229-4311
Mailing Address - Fax:305-229-4388
Practice Address - Street 1:800 MEADOWS RD
Practice Address - Street 2:BOCA COMMUNITY HOSPITAL
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-955-4136
Practice Address - Fax:561-955-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94831OtherBLUE CROSS BLUE SHIELD
FLK7939Medicare ID - Type Unspecified