Provider Demographics
NPI:1235881244
Name:BAMBOO MEDICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:BAMBOO MEDICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATRESSA
Authorized Official - Middle Name:RENESSA
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:941-725-7555
Mailing Address - Street 1:2742 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-8698
Mailing Address - Country:US
Mailing Address - Phone:941-725-7555
Mailing Address - Fax:
Practice Address - Street 1:2742 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-8698
Practice Address - Country:US
Practice Address - Phone:941-725-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory