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General NPI Number Information
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NPI Number | 1932338100
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Entity Type | Organization
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Legal Business Name | HOMEFRONT DIAGNOSTICS INC
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 650 MARKET ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8891
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Country | US
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Telephone | 386-951-6654
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Fax | 386-868-5010
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Provider Business Mailing Address
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Address Line | 650 MARKET ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8891
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Country | US
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Telephone | 386-951-6654
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Fax | 386-868-5010
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Authorized Official
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Title or Position | OWNER
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Name | MR. ERNEST E HALE III
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Credential |
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Telephone | 386-951-6654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | 4CC8494
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | HCC8494
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License Number State | FL
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