Provider Demographics
NPI:1346365533
Name:LIFE CARE DIAGNOSTICS
Entity Type:Organization
Organization Name:LIFE CARE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-522-4433
Mailing Address - Street 1:PO BOX 40123
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-0123
Mailing Address - Country:US
Mailing Address - Phone:727-522-4433
Mailing Address - Fax:727-522-3432
Practice Address - Street 1:6320 39TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-6070
Practice Address - Country:US
Practice Address - Phone:727-522-4433
Practice Address - Fax:727-522-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2023OtherBC BS
FLV2023OtherBC BS
FLV2023OtherBC BS
FLE1849Medicare ID - Type UnspecifiedPROVIDER NUMBER