MEDICARE: IN-HOUSE DIAGNOSTIC SERVICES 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

General Provider Information

NPI Number	:	1992059026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN-HOUSE DIAGNOSTIC SERVICES INC

Provider Business Mailing Address
First Line	:	1489 N MILITARY TRL
Second Line	:	STE 217
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6029
Country	:	US
Telephone Number	:	561-712-1285
Fax Number	:

Provider Business Practice Location Address
First Line	:	1489 N MILITARY TRL
Second Line	:	STE 217
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6029
Country	:	US
Telephone Number	:	561-712-1285
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IVAR S CROES
Credential	:
Telephone Number	:	561-712-1285

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	10/26/2012

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