Organization
FLORIDA CLINICAL LAB,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG DELIGDISH MD (BOARD MEMBER)
(321) 727-3495
Entity
Organization
Contact information
Practice address
27 E HIBISCUS BLVD, MELBOURNE, FL 32901-3171
(321) 308-0868
(321) 308-0873
Mailing address
27 E HIBISCUS BLVD, MELBOURNE, FL 32901-3171
(321) 308-0868
(321) 308-0873
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800017966
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500004100
—
FL
01
—
690009481
RAILROAD MEDICARE
FL
01
—
L9236
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/01/2006
Last updated
05/21/2008
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