Provider Demographics
NPI:1467146324
Name:TREASURE COAST DIAGNOSTIC LABORATORY INCORPORATED
Entity Type:Organization
Organization Name:TREASURE COAST DIAGNOSTIC LABORATORY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUISSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-773-0935
Mailing Address - Street 1:PO BOX 880245
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-0245
Mailing Address - Country:US
Mailing Address - Phone:772-773-0935
Mailing Address - Fax:
Practice Address - Street 1:142 NW SWANN MILL CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3592
Practice Address - Country:US
Practice Address - Phone:772-773-0935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory