Provider Demographics
NPI:1336567999
Name:PATH MEDICAL CENTER INC
Entity type:Organization
Organization Name:PATH MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOGAROS ATLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-735-6584
Mailing Address - Street 1:17325 NW 27TH AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4056
Mailing Address - Country:US
Mailing Address - Phone:954-735-6584
Mailing Address - Fax:954-735-6589
Practice Address - Street 1:17325 NW 27TH AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4056
Practice Address - Country:US
Practice Address - Phone:954-735-6584
Practice Address - Fax:954-735-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty