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General NPI Number Information
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NPI Number | 1578445821
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Entity Type | Organization
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Legal Business Name | ORIGIN DIAGNOSTICS
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 12574 FLAGLER CENTER BLVD STE 101-63
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2614
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Country | US
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Telephone | 800-440-6695
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Fax | 323-203-1648
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Provider Business Mailing Address
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Address Line | 12574 FLAGLER CENTER BLVD STE 101-63
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City | JACKSONVILLE
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State | FL
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Zip | 32258-2614
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Country | US
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Telephone | 800-440-6695
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Fax | 323-203-1648
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Authorized Official
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Title or Position | VP INNOVATION
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Name | BRIAN DREW
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Credential |
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Telephone | 317-502-5695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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