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NPI Code Detail

MEDICARE: FLORIDA MEDICAL LABORATORY GROUP, INC

MEDICARE: FLORIDA MEDICAL LABORATORY GROUP, INC
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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538758958
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORIDA MEDICAL LABORATORY GROUP, INC
Provider Business Mailing Address
First Line : 224 EGLIN PKWY NE STE E
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-2877
Country : US
Telephone Number : 850-374-8573
Fax Number :
Provider Business Practice Location Address
First Line : 224 EGLIN PKWY NE STE E
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-2877
Country : US
Telephone Number : 850-374-8573
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MR. SEMIR AJSIC
Credential :
Telephone Number : 704-904-2862
Provider Enumeration Date : 01/11/2021
Last Update Date : 01/11/2021

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Directions to “FLORIDA MEDICAL LABORATORY GROUP, INC ” Practice Location

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