NPIMap

Organization Active NPI

Florida Department of Health

Doing business as PBCHD Laboratory

  • Clinical Medical Laboratory
  • West Palm Beach, FL
National Provider Identifier
1083678205
Registry record updated Oct 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
800001191 Issued in FL
Legal business name
FLORIDA DEPARTMENT OF HEALTH
Doing business as
PBCHD Laboratory
Practice address
1150 45TH St
Room L-200
West Palm Beach, FL 33407-2361
Phone
(561) 514-5360
Fax
(561) 514-5550
NPI assigned
Apr 14, 2006
Last updated
Oct 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2015

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

Authorized official

Name
Mr. Jesus Edgardo DiazNPI 1497122022
Title
Biological Administrator III
Phone
(561) 514-5360

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 800001191 FL Primary

Addresses

Primary practice location

1150 45TH St
Room L-200
West Palm Beach, FL 33407-2361

Mailing address

PO Box 29
West Palm Beach, FL 33402-0029
Phone (561) 514-5360

Other identifiers 1

IdentifierTypeStateIssuer
030448400MedicaidFL

Other names 1

  • PBCHD Laboratory Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151203003173 FL Part B Supplier - Independent Clinical Laboratory 3072424282 Practice locations: West Palm Beach, FL

National Provider Directory

National Provider Directory
Tax ID family
Agape Community Health185 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1150 45th St
#L200
West Palm Beach, FL 33407
Phone (561) 514-5360

1150 45th St
Rm L200
West Palm Beach, FL 33407
Phone (561) 514-5360

800 Clematis St
Rm 5534
West Palm Beach, FL 33401

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Walton Community Health CenterDefuniak Springs, FL, CCN 101136 Federally qualified health center Operational/Managerial Control (100%) Sep 7, 2010
Bradford Community Health Care IncStarke, FL, CCN 101182 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443657600000",
    "number": "1083678205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334020029",
            "telephone_number": "561-514-5360",
            "fax_number": "561-514-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 45TH ST",
            "address_2": "ROOM L-200",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072361",
            "telephone_number": "561-514-5360",
            "fax_number": "561-514-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2015-10-01",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "JESUS",
        "authorized_official_middle_name": "EDGARDO",
        "authorized_official_title_or_position": "BIOLOGICAL ADMINISTRATOR III",
        "authorized_official_telephone_number": "561-514-5360",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800001191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030448400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PBCHD Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.