SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC

Provider Demographics

• NPI: 1932376233
• Name: SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
• Entity Type: Organization
• Organization Name: SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
• Other - Org Name: TRIDENTCARE
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: AUTHORIZED OFFICIAL/CFO
• Authorized Official - First Name: BRIAN
• Authorized Official - Middle Name: C
• Authorized Official - Last Name: CUOMO
• Authorized Official - Phone: 800-786-8015
• Mailing Address - Street 1: 930 RIDGEBROOK RD FL 3
• Mailing Address - City: SPARKS
• Mailing Address - State: MD
• Mailing Address - Zip Code: 21152-9481
• Mailing Address - Country: US
• Mailing Address - Phone: 800-786-8015
• Mailing Address - Fax: 443-662-4230
• Practice Address - Street 1: 4400 140TH AVE N STE 200
• Practice Address - City: CLEARWATER
• Practice Address - State: FL
• Practice Address - Zip Code: 33762-3813
• Practice Address - Country: US
• Practice Address - Phone: 800-786-8015
• Practice Address - Fax: 443-842-7264
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-05-15
• Last Update Date: 2024-01-31

Provider Licenses

State	License ID	Taxonomies
PA	3008665	293D00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	293D00000X	Laboratories	Physiological Laboratory

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	8105030	Medicaid
MA	110029440B	Medicaid
PA	0014859080025	Medicaid
CT	004222098	Medicaid
LA	2396978	Medicaid
NM	92623514	Medicaid
RI	9419801	Medicaid
TX	086063702	Medicaid
WI	42507500	Medicaid
IL	========= 002	Medicaid
MA	110029440B	Medicaid
FL	CX683A	Medicare PIN
RI	P00342225	Medicare PIN
MA	P00344027	Medicare PIN
CT	470000035	Medicare PIN
FL	P00836869	Medicare PIN
PA	0014859080025	Medicaid
WI	42507500	Medicaid
TX	086063702	Medicaid
CT	004222098	Medicaid
TX	FTA027	Medicare PIN
NJ	P00342192	Medicare PIN
MA	327067	Medicare PIN
PA	P00342224	Medicare PIN
NC	2881831	Medicare PIN