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Contact Information

VIVID PATHOLOGY PA
4900 BAYOU BLVD STE 204
PENSACOLA, FL32503-2533
 Phone: 850-867-8177
 Fax: 850-876-6727
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anatomic Pathology & Clinical Pathology

207ZP0102X 22 Physician/Pathology
 

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
 

Cytopathology

207ZC0500X 22 Physician/Pathology
Indicates primary specialty

NPI Profile & details for VIVID PATHOLOGY PA

NPI Number 1447227590
LBN Legal business name VIVID PATHOLOGY PA
Authorized official CHRISTOPHER DADISMAN - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 03/07/2006
Last updated 01/15/2026 - About 5 months ago
Identifiers
FL License # 65194
FL License # ME53456
AL Medicaid 529001600
FL Medicaid 064208800
FL Other 00378 BCBS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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