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NPI Code Detail

MEDICARE: FLL DIAGNOSTICS, LLC

MEDICARE: FLL DIAGNOSTICS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1205191442
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLL DIAGNOSTICS, LLC
Provider Business Mailing Address
First Line : PO BOX 7240
Second Line :
City : JUPITER
State : FL
Zip : 33468-7240
Country : US
Telephone Number : 561-748-2889
Fax Number : 561-748-1523
Provider Business Practice Location Address
First Line : 2331 NE 53RD ST
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33308-3235
Country : US
Telephone Number : 954-491-9700
Fax Number :
Authorized Official
Title or Position : JUPITER PROFESSIONAL DEVELOPMENT
Name : KAREN BARLOW
Credential : PRESIDENT
Telephone Number : 561-748-2889
Provider Enumeration Date : 07/12/2012
Last Update Date : 06/11/2013

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Directions to “FLL DIAGNOSTICS, LLC ” Practice Location

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