Provider Demographics
NPI:1811232523
Name:FISHERMEN'S WAY LLC
Entity type:Organization
Organization Name:FISHERMEN'S WAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE OWNER/ DIR. OF MARKETING
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:443-716-8419
Mailing Address - Street 1:131 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-4286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:131 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4286
Practice Address - Country:US
Practice Address - Phone:443-716-8419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory