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General NPI Number Information
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NPI Number | 1134786775
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Entity Type | Organization
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Legal Business Name | STONE CLINICAL LABORATORIES OF FL LLC
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 315 SERENOA RD STE A
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-5093
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Country | US
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Telephone | 502-931-0408
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746441
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City | ATLANTA
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State | GA
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Zip | 30374-6441
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Country | US
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Telephone | 502-931-0408
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Fax |
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Authorized Official
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Title or Position | CEO AND FOUNDER
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Name | MR. CHRISTOPHER MARTIN RIDGEWAY
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Credential |
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Telephone | 504-827-1050
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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 |
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