Provider Demographics
NPI:1376599530
Name:HEMACON LABORATORIES
Entity Type:Organization
Organization Name:HEMACON LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COOLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PANTAZIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-372-7114
Mailing Address - Street 1:PO BOX 5773
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-5773
Mailing Address - Country:US
Mailing Address - Phone:352-372-7114
Mailing Address - Fax:352-372-7714
Practice Address - Street 1:106 SW 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6200
Practice Address - Country:US
Practice Address - Phone:352-372-7114
Practice Address - Fax:352-372-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE9186Medicare PIN