Provider Demographics
NPI:1235480641
Name:MEDSTAR LABORATORY OF FLORIDA, INC
Entity Type:Organization
Organization Name:MEDSTAR LABORATORY OF FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:VESSELOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-291-4292
Mailing Address - Street 1:10277 WINDHORST RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7820
Mailing Address - Country:US
Mailing Address - Phone:844-291-4292
Mailing Address - Fax:813-628-9319
Practice Address - Street 1:10277 WINDHORST RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7820
Practice Address - Country:US
Practice Address - Phone:844-291-4292
Practice Address - Fax:813-628-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory