Provider Demographics
NPI:1316366586
Name:ACCESS DIAGNOSTIC INSTITUTE LLC
Entity Type:Organization
Organization Name:ACCESS DIAGNOSTIC INSTITUTE LLC
Other - Org Name:RRAL ENTERPRISES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-388-4056
Mailing Address - Street 1:2113 RUBY RED BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6115
Mailing Address - Country:US
Mailing Address - Phone:352-324-6279
Mailing Address - Fax:888-700-8819
Practice Address - Street 1:2113 RUBY RED BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6115
Practice Address - Country:US
Practice Address - Phone:352-324-6198
Practice Address - Fax:888-700-8819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RRAL ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-15
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHW737AMedicare PIN