Organization
EXCEL DIAGNOSTIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PREM D JAGERNAUTH RVT,RDMS,RDCS (MANAGER)
(727) 521-0129
Entity
Organization
Contact information
Practice address
1109 DARLINGTON OAK DR NE, ST PETERSBURG, FL 33703-6314
(727) 521-0129
(727) 521-0130
Mailing address
1109 DARLINGTON OAK DR NE, ST PETERSBURG, FL 33703-6314
(727) 521-0129
(727) 521-0130
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
HCC5616
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3580285
AETNA
FL
01
—
V2896
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/12/2005
Last updated
09/18/2007
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