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General NPI Number Information
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NPI Number | 1093878266
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Entity Type | Organization
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Legal Business Name | HERNDON DIAGNOSTIC LABORATORY INC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 720 COMMERCE CENTER DR STE D
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City | SEBASTIAN
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State | FL
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Zip | 32958-3122
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Country | US
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Telephone | 772-581-1079
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Fax | 772-581-1081
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Provider Business Mailing Address
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Address Line | 720 COMMERCE CENTER DR STE D
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City | SEBASTIAN
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State | FL
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Zip | 32958-3122
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Country | US
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Telephone | 772-581-1079
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Fax | 772-581-1081
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM C. HERNDON JR.
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Credential |
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Telephone | 772-581-1079
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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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