Organization
OAKRIDGE CLINICAL LAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRITZ PHANORD (MANAGER BUSINESS OFFICE)
95495870606
Entity
Organization
Contact information
Practice address
1000 NE 56TH ST, ATTN BUSINESS OFFICE, FORT LAUDERDALE, FL 33334-4149
(954) 958-0606
(954) 116-0821
Mailing address
1000 NE 56TH ST, ATTN BUSINESS OFFICE, FORT LAUDERDALE, FL 33334-4149
(954) 958-0606
(954) 116-0821
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L9099
BC BS PROVIDER ID
FL
Enumeration date
01/23/2007
Last updated
08/22/2020
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