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General NPI Number Information
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NPI Number | 1386615730
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Entity Type | Organization
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Legal Business Name | FLORIDA CLINICAL LAB,INC
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 27 E HIBISCUS BLVD
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City | MELBOURNE
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State | FL
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Zip | 32901-3171
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Country | US
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Telephone | 321-308-0868
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Fax | 321-308-0873
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Provider Business Mailing Address
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Address Line | 27 E HIBISCUS BLVD
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City | MELBOURNE
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State | FL
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Zip | 32901-3171
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Country | US
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Telephone | 321-308-0868
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Fax | 321-308-0873
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Authorized Official
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Title or Position | BOARD MEMBER
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Name | CRAIG DELIGDISH
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Credential | MD
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Telephone | 321-727-3495
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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 | 800017966
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License Number State | FL
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