Provider Demographics
NPI:1326140716
Name:DIAGNOSTIC AND CLINICAL CARE SERVICES INC
Entity Type:Organization
Organization Name:DIAGNOSTIC AND CLINICAL CARE SERVICES INC
Other - Org Name:DOCCS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAGMANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-752-7100
Mailing Address - Street 1:2100 N WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8110
Mailing Address - Country:US
Mailing Address - Phone:321-752-7100
Mailing Address - Fax:321-752-7105
Practice Address - Street 1:2100 N WICKHAM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2300
Practice Address - Country:US
Practice Address - Phone:321-752-7100
Practice Address - Fax:321-752-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB493Medicare PIN