MEDICARE: FLORIDA LABS, 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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1437967395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA LABS, LLC

Provider Business Mailing Address
First Line	:	9310 OLD KINGS RD S STE 704
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6178
Country	:	US
Telephone Number	:	904-586-6973
Fax Number	:

Provider Business Practice Location Address
First Line	:	9310 OLD KINGS RD S STE 704
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-6178
Country	:	US
Telephone Number	:	904-586-6973
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAWSON SMITH
Credential	:
Telephone Number	:	904-586-6973

Provider Enumeration Date	:	12/24/2024
Last Update Date	:	12/24/2024

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Directions to “FLORIDA LABS, LLC ” Practice Location

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