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General NPI Number Information
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NPI Number | 1235480641
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Entity Type | Organization
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Legal Business Name | MEDSTAR LABORATORY OF FLORIDA, INC
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 10277 WINDHORST RD
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City | TAMPA
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State | FL
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Zip | 33619-7820
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Country | US
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Telephone | 844-291-4292
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Fax | 813-628-9319
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Provider Business Mailing Address
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Address Line | 10277 WINDHORST RD
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City | TAMPA
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State | FL
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Zip | 33619-7820
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Country | US
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Telephone | 844-291-4292
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Fax | 813-628-9319
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Authorized Official
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Title or Position | CEO
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Name | MR. KIRILL VESSELOV
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Credential |
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Telephone | 844-291-4292
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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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