Provider Demographics
NPI:1417062076
Name:FLORIDA CLINICAL LABORATORY, INC
Entity Type:Organization
Organization Name:FLORIDA CLINICAL LABORATORY, INC
Other - Org Name:BIOREFERENCE HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-791-2600
Mailing Address - Street 1:481 EDWARD H ROSS DR
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3118
Mailing Address - Country:US
Mailing Address - Phone:800-229-5227
Mailing Address - Fax:201-791-1941
Practice Address - Street 1:27 E HIBISCUS BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3114
Practice Address - Country:US
Practice Address - Phone:800-229-5227
Practice Address - Fax:321-308-0868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOREFERENCE HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCLIA 10D1003031291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009682500Medicaid
FL009682500Medicaid