Healthcare Provider Details

I. General information

NPI: 1316486566
Provider Name (Legal Business Name): ATLAS DIAGNOSTIC HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 HIGHLAND MANOR DR STE 200
TAMPA FL
33610-9712
US

IV. Provider business mailing address

4023 N ARMENIA AVE
TAMPA FL
33607-1017
US

V. Phone/Fax

Practice location:
  • Phone: 718-789-1818
  • Fax: 718-789-1616
Mailing address:
  • Phone: 813-443-2185
  • Fax: 813-443-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberHCC12300
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHESKEL REICH
Title or Position: OWNER
Credential:
Phone: 917-468-7480