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General NPI Number Information
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NPI Number | 1285447623
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Entity Type | Organization
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Legal Business Name | CRANE CREEK LAB LLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 1600 SARNO RD STE 10
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City | MELBOURNE
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State | FL
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Zip | 32935-4992
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Country | US
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Telephone | 904-586-6973
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Fax | 321-334-6515
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Provider Business Mailing Address
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Address Line | 1600 SARNO RD STE 10
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City | MELBOURNE
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State | FL
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Zip | 32935-4992
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Country | US
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Telephone | 904-586-6973
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Fax | 321-334-6515
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Authorized Official
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Title or Position | OWNER
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Name | DAWSON SMITH
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Credential |
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Telephone | 904-586-6973
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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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