Provider Demographics
NPI:1730130378
Name:ARTEMISA DIAGNOSTIC MOBILE CORPORATION
Entity Type:Organization
Organization Name:ARTEMISA DIAGNOSTIC MOBILE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARTEAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-223-9800
Mailing Address - Street 1:1401 SW 107TH AVE
Mailing Address - Street 2:301J
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2524
Mailing Address - Country:US
Mailing Address - Phone:305-223-9800
Mailing Address - Fax:305-223-9810
Practice Address - Street 1:1401 SW 107TH AVE
Practice Address - Street 2:301J
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2524
Practice Address - Country:US
Practice Address - Phone:305-223-9800
Practice Address - Fax:305-223-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5831XMedicare PIN
FLE1163NMedicare PIN
FLK5447Medicare PIN