Organization
MEDICAL DIAGNOSTIC SERVICES OF CENTRAL FLORIDA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN B OSULLIVAN ROCS (CEO)
(352) 489-5873
Entity
Organization
Contact information
Practice address
1150 HWY 41, JASPER, FL 32052-1150
(386) 792-2662
(386) 792-2662
Mailing address
5515 W OAKHILL ST, DUNNELLON, FL 34438-2534
(352) 489-5873
(352) 489-5873
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225296
AV MED
FL
01
—
V2017
BCBS
FL
Enumeration date
02/27/2007
Last updated
08/22/2020
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