Provider Demographics
NPI:1952825481
Name:FIRST COAST LABORATORIES
Entity Type:Organization
Organization Name:FIRST COAST LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-551-2434
Mailing Address - Street 1:6900 SOUTHPOINT DR N STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8008
Mailing Address - Country:US
Mailing Address - Phone:904-551-2434
Mailing Address - Fax:904-337-0673
Practice Address - Street 1:6900 SOUTHPOINT DR N STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8008
Practice Address - Country:US
Practice Address - Phone:904-551-2434
Practice Address - Fax:904-337-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSU37015OtherDEPARTMENT OF HEALTH LICENSE