Provider Demographics
NPI:1881083467
Name:CONCISE DIAGNOSTICS CORP
Entity type:Organization
Organization Name:CONCISE DIAGNOSTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ODETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-909-0132
Mailing Address - Street 1:5400 S UNIVERSITY DR
Mailing Address - Street 2:305B
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5312
Mailing Address - Country:US
Mailing Address - Phone:954-909-0132
Mailing Address - Fax:
Practice Address - Street 1:5400 S UNIVERSITY DR
Practice Address - Street 2:305C
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5312
Practice Address - Country:US
Practice Address - Phone:954-909-0132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U0000X291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory