Provider Demographics
NPI:1811379001
Name:DIAGNOSTIC SOLUTIONS LABORATORY, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC SOLUTIONS LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-485-5336
Mailing Address - Street 1:31 LUPI CT STE 250
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4762
Mailing Address - Country:US
Mailing Address - Phone:877-485-5336
Mailing Address - Fax:470-239-5017
Practice Address - Street 1:5895 SHILOH RD STE 101
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2271
Practice Address - Country:US
Practice Address - Phone:877-485-5336
Practice Address - Fax:470-239-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory