Provider Demographics
NPI:1306079447
Name:PATHOLOGY SERVICES ALLIANCE LLC
Entity type:Organization
Organization Name:PATHOLOGY SERVICES ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-5002
Mailing Address - Street 1:1456 WILLIAM ST
Mailing Address - Street 2:ATTN: LORETTA ROSENBALM
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3824
Mailing Address - Country:US
Mailing Address - Phone:352-787-1778
Mailing Address - Fax:352-787-1164
Practice Address - Street 1:732 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4442
Practice Address - Country:US
Practice Address - Phone:352-787-1778
Practice Address - Fax:352-787-1164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEESBURG REGIONAL MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-24
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty