Organization
GRANITE DIAGNOSTIC LABORATORIES, INC.
Active
Other names
Granite Diagnostic Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAIN D GRANITE (OWNER)
(727) 771-6343
Entity
Organization
Contact information
Practice address
2150 ALT 19, SUITE A, PALM HARBOR, FL 34683-5363
(727) 771-6343
(727) 771-2942
Mailing address
2150 ALT 19, SUITE A, PALM HARBOR, FL 34683-5363
(727) 771-6343
(727) 771-2942
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800009395
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030705000
—
FL
Enumeration date
08/04/2006
Last updated
01/07/2013
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