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General NPI Number Information
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NPI Number | 1518983642
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Entity Type | Organization
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Legal Business Name | BUREAU OF PUBLIC HEALTH LABORATORIES
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 1217 PEARL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3926
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Country | US
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Telephone | 904-791-1690
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Fax | 904-791-1690
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Provider Business Mailing Address
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Address Line | 1217 N PEARL ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3926
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Country | US
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Telephone | 904-791-1690
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Fax | 904-791-1690
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Authorized Official
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Title or Position | JACKSONVILLE LAB DIRECTOR
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Name | MRS. SUSANNE R CROWE
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Credential |
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Telephone | 904-791-1550
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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 | 800000296
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License Number State | FL
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