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General NPI Number Information
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NPI Number | 1285707943
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Entity Type | Organization
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Legal Business Name | INDEPENDENT CLINICAL LABORATORIES LLC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 3110 CHERRY PALM DR SUITE 340
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City | TAMPA
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State | FL
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Zip | 33619-8304
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Country | US
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Telephone | 813-932-0374
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Fax | 813-931-0658
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Provider Business Mailing Address
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Address Line | 22 WESTEDGE ST STE 800
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City | CHARLESTON
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State | SC
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Zip | 29403-6984
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Country | US
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Telephone | 854-429-1069
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Fax | 833-247-4091
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Authorized Official
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Title or Position | COO
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Name | DANIEL NODES
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Credential |
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Telephone | 843-754-7748
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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 | 800001312
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License Number State | FL
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