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General NPI Number Information
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NPI Number | 1760930697
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Entity Type | Organization
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Legal Business Name | DYNIX DIAGNOSTIX
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 2260 N US HIGHWAY 1
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City | FORT PIERCE
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State | FL
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Zip | 34946-8913
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Country | US
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Telephone | 844-514-8158
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Fax |
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Provider Business Mailing Address
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Address Line | 2260 N US HIGHWAY 1
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City | FORT PIERCE
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State | FL
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Zip | 34946-8913
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Country | US
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Telephone | 844-514-8158
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. SEAN ALTERMAN
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Credential |
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Telephone | 732-589-0579
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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 |
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License Number State |
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