Healthcare Provider Details

I. General information

NPI: 1083609127
Provider Name (Legal Business Name): RMG ART LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 E FLETCHER AVE SUITE 2
TAMPA FL
33617-1126
US

IV. Provider business mailing address

5245 E FLETCHER AVE SUITE 2
TAMPA FL
33617-1126
US

V. Phone/Fax

Practice location:
  • Phone: 813-914-7304
  • Fax: 813-914-7314
Mailing address:
  • Phone: 813-914-7304
  • Fax: 813-914-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800020271
License Number StateFL

VIII. Authorized Official

Name: MARC A BERNHISEL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 813-914-7304