Provider Demographics
NPI:1467776963
Name:NATIONAL DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:NATIONAL DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:ROLLYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-754-2343
Mailing Address - Street 1:110 W REYNOLDS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3380
Mailing Address - Country:US
Mailing Address - Phone:813-754-2343
Mailing Address - Fax:866-316-0202
Practice Address - Street 1:110 W REYNOLDS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3380
Practice Address - Country:US
Practice Address - Phone:813-754-2343
Practice Address - Fax:866-316-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory