Provider Demographics
NPI:1053754028
Name:HEALTHPATH MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:HEALTHPATH MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOSTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-359-7200
Mailing Address - Street 1:201 NW 82ND AVE STE 203B
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1854
Mailing Address - Country:US
Mailing Address - Phone:954-472-7169
Mailing Address - Fax:954-473-3313
Practice Address - Street 1:201 NW 82ND AVE STE 203B
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1854
Practice Address - Country:US
Practice Address - Phone:954-472-7169
Practice Address - Fax:954-473-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23433261QP2300X
FLHCC9758261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care