MEDICARE: INFINITY DIAGNOSTICS, 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
1	293D00000X	Physiological Laboratory	HCC6647	FL

General Provider Information

NPI Number	:	1588693469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITY DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	3450 NORTHLAKE BLVD STE 103
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1709
Country	:	US
Telephone Number	:	561-630-6900
Fax Number	:	561-630-9644

Provider Business Practice Location Address
First Line	:	3450 NORTHLAKE BLVD STE 103
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33403-1709
Country	:	US
Telephone Number	:	561-630-6900
Fax Number	:	561-630-9644

Authorized Official
Title or Position	:	SECRETARY
Name	:	JONATHAN JAMES FEDELE
Credential	:
Telephone Number	:	561-630-9600

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	08/22/2020

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