Organization
TAMPA BAY DIAGNOSTIC INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW B CHANDLER MS, MTASCP (OWNER)
(212) 734-6621
Entity
Organization
Contact information
Practice address
106 N EVERS ST, PLANT CITY, FL 33563-3330
(813) 763-5607
Mailing address
4085 HEMLOCK LN, TITUSVILLE, FL 32780-2822
(813) 763-5607
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31315
COLA
FL
Enumeration date
08/27/2021
Last updated
08/06/2024
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