Healthcare Provider Details

I. General information

NPI: 1205769536
Provider Name (Legal Business Name): MEDSOUTHFL LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 BISCAYNE BLVD # 800-15
NORTH MIAMI FL
33181-2541
US

IV. Provider business mailing address

12550 BISCAYNE BLVD # 800-15
NORTH MIAMI FL
33181-2541
US

V. Phone/Fax

Practice location:
  • Phone: 786-677-2489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291900000X
TaxonomyMilitary Clinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: GREG LUBIN
Title or Position: PRESIDENT
Credential:
Phone: 305-789-6543