Provider Demographics
NPI:1154306140
Name:SOUTH FLORIDA DIAGNOSTICS INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:954-792-6038
Mailing Address - Street 1:1380 NW 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4555
Mailing Address - Country:US
Mailing Address - Phone:954-792-6038
Mailing Address - Fax:954-792-6233
Practice Address - Street 1:1380 NW 65TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4555
Practice Address - Country:US
Practice Address - Phone:954-792-6038
Practice Address - Fax:954-792-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0307530001Medicare ID - Type Unspecified