Provider Demographics
NPI:1922726033
Name:JOURNEY DIAGNOSTICS MEDICAL SERVICE LLC
Entity Type:Organization
Organization Name:JOURNEY DIAGNOSTICS MEDICAL SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:CLINIQUE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMY
Authorized Official - Phone:352-484-6647
Mailing Address - Street 1:10483 N FLORIDA AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34434-3268
Mailing Address - Country:US
Mailing Address - Phone:352-484-6647
Mailing Address - Fax:
Practice Address - Street 1:10483 N FLORIDA AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34434-3268
Practice Address - Country:US
Practice Address - Phone:352-484-6647
Practice Address - Fax:844-907-3024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory