Provider Demographics
NPI:1760429559
Name:DIAGNOSTIC SERVICES INC
Entity Type:Organization
Organization Name:DIAGNOSTIC SERVICES INC
Other - Org Name:DSI LABORATORIES AT BONITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO EVP TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-222-7566
Mailing Address - Street 1:PO BOX 2240
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-2240
Mailing Address - Country:US
Mailing Address - Phone:800-222-7566
Mailing Address - Fax:
Practice Address - Street 1:3501 HEALTH CENTER BLVD
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-8127
Practice Address - Country:US
Practice Address - Phone:239-561-8201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30578200Medicaid
FLE9091Medicare ID - Type Unspecified