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General NPI Number Information
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NPI Number | 1144579103
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Entity Type | Organization
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Legal Business Name | EMERALD DIAGNOSTIC SERVICES CORP
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 7911 NW 72ND AVE SUITE 206
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City | MEDLEY
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State | FL
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Zip | 33166-2227
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Country | US
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Telephone | 786-536-4439
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Fax | 786-536-6572
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Provider Business Mailing Address
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Address Line | 7911 NW 72ND AVE SUITE 206
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City | MEDLEY
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State | FL
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Zip | 33166-2227
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Country | US
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Telephone | 786-536-4439
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Fax | 786-536-6572
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD ESCOTO
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Credential |
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Telephone | 786-536-4439
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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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