MEDICARE: GSB 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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1962355941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GSB DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	300 NE 75TH ST UNIT 110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-5294
Country	:	US
Telephone Number	:	786-703-7778
Fax Number	:	386-381-1082

Provider Business Practice Location Address
First Line	:	300 NE 75TH ST UNIT 110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-5294
Country	:	US
Telephone Number	:	786-703-7778
Fax Number	:	386-381-1082

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GRADY D KITTRELL
Credential	:
Telephone Number	:	786-703-7778

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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