Provider Demographics
NPI:1093764508
Name:DIAGNOSTIC HEALTH CORPORATION
Entity Type:Organization
Organization Name:DIAGNOSTIC HEALTH CORPORATION
Other - Org Name:DIAGNOSTIC HEALTH, ORANGE PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TUYEN
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-981-4849
Mailing Address - Street 1:22 INVERNESS CENTER PKWY
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4814
Mailing Address - Country:US
Mailing Address - Phone:205-981-4848
Mailing Address - Fax:
Practice Address - Street 1:2128 PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5584
Practice Address - Country:US
Practice Address - Phone:904-264-9922
Practice Address - Fax:904-264-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3823EMedicare PIN