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NPI Code Detail

MEDICARE: STONE CLINICAL LABORATORIES OF FL LLC

MEDICARE: STONE CLINICAL LABORATORIES OF FL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134786775
Entity Type Code : Organization
Provider Name (Legal Business Name) : STONE CLINICAL LABORATORIES OF FL LLC
Provider Business Mailing Address
First Line : PO BOX 746441
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6441
Country : US
Telephone Number : 502-931-0408
Fax Number :
Provider Business Practice Location Address
First Line : 315 SERENOA RD STE A
Second Line :
City : SANTA ROSA BEACH
State : FL
Zip : 32459-5093
Country : US
Telephone Number : 502-931-0408
Fax Number :
Authorized Official
Title or Position : CEO AND FOUNDER
Name : MR. CHRISTOPHER MARTIN RIDGEWAY
Credential :
Telephone Number : 504-827-1050
Provider Enumeration Date : 05/20/2019
Last Update Date : 09/27/2023

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Directions to “STONE CLINICAL LABORATORIES OF FL LLC ” Practice Location

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