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General NPI Number Information
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NPI Number | 1306240171
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Entity Type | Organization
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Legal Business Name | TOTAL LAB CARE LLC
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 7685 103RD ST SUITE A1
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City | JACKSONVILLE
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State | FL
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Zip | 32210-9325
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Country | US
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Telephone | 904-647-7404
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Fax | 904-394-5115
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Provider Business Mailing Address
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Address Line | 7685 103RD ST SUITE A1
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City | JACKSONVILLE
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State | FL
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Zip | 32210-9325
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Country | US
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Telephone | 904-647-7404
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Fax | 904-394-5115
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYED S HUSSAIN
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Credential | MD
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Telephone | 904-647-7404
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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 | 800027316
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License Number State | FL
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