Healthcare Provider Details

I. General information

NPI: 1265638894
Provider Name (Legal Business Name): ONSITE DIAGNOSTICS OF AMERICA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 W OAKLAND PARK BLVD SUITE 305
TAMARAC FL
33319-4982
US

IV. Provider business mailing address

7501 W OAKLAND PARK BLVD SUITE 305
TAMARAC FL
33319-4982
US

V. Phone/Fax

Practice location:
  • Phone: 954-749-2800
  • Fax: 954-749-2890
Mailing address:
  • Phone: 954-749-2800
  • Fax: 954-749-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ARLAN HALLMAN
Title or Position: PRESIDENT
Credential: LMT
Phone: 954-749-2800