Provider Demographics
NPI:1003229022
Name:LOGIC DIAGNOSTICS INC
Entity Type:Organization
Organization Name:LOGIC DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIACAMAN SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-278-9088
Mailing Address - Street 1:PO BOX 820636
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-0636
Mailing Address - Country:US
Mailing Address - Phone:954-278-9088
Mailing Address - Fax:954-607-5825
Practice Address - Street 1:18501 PINES BLVD
Practice Address - Street 2:STE 205B
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1414
Practice Address - Country:US
Practice Address - Phone:954-278-9088
Practice Address - Fax:954-607-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No291U00000XLaboratoriesClinical Medical Laboratory