Provider Demographics
NPI:1891721536
Name:INNOVATIVE GX FLORIDA , INC
Entity Type:Organization
Organization Name:INNOVATIVE GX FLORIDA , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-235-3883
Mailing Address - Street 1:4805 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4141
Mailing Address - Country:US
Mailing Address - Phone:561-235-3883
Mailing Address - Fax:561-367-3218
Practice Address - Street 1:4805 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4141
Practice Address - Country:US
Practice Address - Phone:561-235-3883
Practice Address - Fax:561-367-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800009934291U00000X
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017475300Medicaid
FL690008878Medicare UPIN
690008878Medicare PIN
FLL9026Medicare PIN