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General NPI Number Information
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NPI Number | 1003229022
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Entity Type | Organization
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Legal Business Name | LOGIC DIAGNOSTICS INC
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 8380 Baymeadows Rd STE 17
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City | Jacksonville
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State | FL
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Zip | 32256
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Country | US
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Telephone | 904-440-0998
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Fax | 904-257-8333
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Provider Business Mailing Address
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Address Line | PO BOX 820636
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City | PEMBROKE PINES
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State | FL
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Zip | 33082-0636
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Country | US
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Telephone | 954-278-9088
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Fax | 954-866-9826
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. NICOLAS GIACAMAN SALGADO
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Credential |
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Telephone | 954-278-9088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Radiology, Mobile
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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