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General NPI Number Information
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NPI Number | 1073662755
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Entity Type | Organization
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Legal Business Name | EAST COAST CLINICAL SERVICES INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 777 37TH ST A-107
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-569-6000
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Fax | 772-569-6066
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Provider Business Mailing Address
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Address Line | 777 37TH ST A-107
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-569-6000
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Fax | 772-569-6066
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MRS. LISA M. BOUTWELL-PITTMAN
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Credential |
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Telephone | 772-569-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | FL
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