Provider Demographics
NPI:1700562311
Name:COLUMBIA MEDICAL IDTF LLC
Entity Type:Organization
Organization Name:COLUMBIA MEDICAL IDTF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:MARAZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-381-7110
Mailing Address - Street 1:6600 NW 16TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-4554
Mailing Address - Country:US
Mailing Address - Phone:954-381-7110
Mailing Address - Fax:754-206-3958
Practice Address - Street 1:6600 NW 16TH ST STE 1
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4554
Practice Address - Country:US
Practice Address - Phone:954-381-7110
Practice Address - Fax:754-206-3958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-27
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory