Provider Demographics
NPI:1215170774
Name:FIRSTPATH LABORATORY SERVICES LLC
Entity type:Organization
Organization Name:FIRSTPATH LABORATORY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-851-8110
Mailing Address - Street 1:6330 N ANDREWS AVE # 253
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2130
Mailing Address - Country:US
Mailing Address - Phone:954-977-6977
Mailing Address - Fax:972-634-6312
Practice Address - Street 1:3141 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4806
Practice Address - Country:US
Practice Address - Phone:954-977-6977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800020850291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001999100 - MCNABMedicaid
P00842971OtherRAILROAD MEDICARE
FLL9310OtherBCBS OF FL
FLL9310OtherBCBS OF FL