Provider Demographics
NPI:1629515986
Name:OL FLORIDA, LLC
Entity Type:Organization
Organization Name:OL FLORIDA, LLC
Other - Org Name:OZARK LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MACALEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-876-2994
Mailing Address - Street 1:901 NORTHPOINT PKWY
Mailing Address - Street 2:120
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1951
Mailing Address - Country:US
Mailing Address - Phone:888-692-7508
Mailing Address - Fax:561-429-5044
Practice Address - Street 1:901 NORTHPOINT PKWY
Practice Address - Street 2:120
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1951
Practice Address - Country:US
Practice Address - Phone:888-692-7508
Practice Address - Fax:561-429-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2108205291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory