NPIMap

Organization Active NPI

Melbourne Medical Laboratory LLC

  • Clinical Medical Laboratory
  • Melbourne, FL
National Provider Identifier
1013353200
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
MELBOURNE MEDICAL LABORATORY LLC
Practice address
95 Bulldog Blvd
Suite 103
Melbourne, FL 32901-3332
Phone
(321) 722-1766
Fax
(321) 722-0346
NPI assigned
May 15, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Craig Deligdish, MDNPI 1679564462
Title
President
Phone
(321) 727-2990

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

95 Bulldog Blvd
Suite 103
Melbourne, FL 32901-3332

Mailing address

95 Bulldog Blvd
Suite 202
Melbourne, FL 32901-3332
Phone (321) 727-2990

National Provider Directory

National Provider Directory

Locations

95 Bulldog Blvd
Ste 103
Melbourne, FL 32901
Phone (321) 409-9990

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1013353200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 BULLDOG BLVD",
            "address_2": "SUITE 202",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013332",
            "telephone_number": "321-727-2990",
            "fax_number": "321-724-0455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 BULLDOG BLVD",
            "address_2": "SUITE 103",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013332",
            "telephone_number": "321-722-1766",
            "fax_number": "321-722-0346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELBOURNE MEDICAL LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-15",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "DELIGDISH",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-727-2990",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.