MEDICARE: DOLPHIN III 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1770785305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOLPHIN III DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	8833 MITCHELL BLVD
Second Line	:	SUITE 8815
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-4407
Country	:	US
Telephone Number	:	727-797-8461
Fax Number	:	727-797-8467

Provider Business Practice Location Address
First Line	:	8833 MITCHELL BLVD
Second Line	:	SUITE 8815
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-4407
Country	:	US
Telephone Number	:	727-797-8461
Fax Number	:	727-797-8467

Authorized Official
Title or Position	:	DIRECTOR OPERATIONS
Name	:	MR. JOHN J. DOLLINGER
Credential	:
Telephone Number	:	727-797-8461

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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