Provider Demographics
NPI:1023434255
Name:MEDNET INC
Entity type:Organization
Organization Name:MEDNET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:954-205-2159
Mailing Address - Street 1:1515 N UNIVERSITY DR
Mailing Address - Street 2:STE 215D
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6096
Mailing Address - Country:US
Mailing Address - Phone:954-753-5800
Mailing Address - Fax:
Practice Address - Street 1:1515 N UNIVERSITY DR
Practice Address - Street 2:STE 215D
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6096
Practice Address - Country:US
Practice Address - Phone:954-753-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1538168075Medicare UPIN
FL1538501978Medicare UPIN