Provider Demographics
NPI:1932498730
Name:ADVANCED DIAGNOSTIC SOLUTIONS INC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-293-2810
Mailing Address - Street 1:3633 LITTLE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1815
Mailing Address - Country:US
Mailing Address - Phone:352-293-2810
Mailing Address - Fax:727-264-2117
Practice Address - Street 1:3633 LITTLE RD STE 103
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1815
Practice Address - Country:US
Practice Address - Phone:352-293-2810
Practice Address - Fax:727-264-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9256293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV006KOtherBCBS
FLV006KOtherBCBS