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General NPI Number Information
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NPI Number | 1982743837
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Entity Type | Organization
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Legal Business Name | MEDICAL DIAGNOSTIC NETWORK, INC.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 184 GOLFVIEW DR
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City | TEQUESTA
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State | FL
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Zip | 33469-1921
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Country | US
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Telephone | 561-745-5450
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Fax | 561-972-7565
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Provider Business Mailing Address
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Address Line | PO BOX 4633
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City | TEQUESTA
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State | FL
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Zip | 33469-1024
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Country | US
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Telephone | 561-745-5450
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Fax | 561-972-7565
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY GREENWOOD
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Credential |
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Telephone | 561-745-5450
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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 | HCC4668
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License Number State | FL
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