Florida Clinical Laboratory, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

800025918 Issued in FL

Legal business name

FLORIDA CLINICAL LABORATORY, INC

Practice address

5912 Breckenridge Pkwy
Tampa, FL 33610-4200

Phone

(904) 562-1401

Fax

(904) 672-1603

NPI assigned

May 22, 2014

Organization subpart

Yes

Parent organization

BIO-REFERENCE LABORATORIES, INCAs reported in NPPES

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

Authorized official

Name

Mr. Warren W Erdmann

Title

Coo; Executive VP

Phone

(201) 791-2600

Specialties & licenses 1

Addresses

Part of

Bio Reference Lab Inc

Locations

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523404800000",
    "number": "1104238302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 EDWARD H ROSS DR",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074073118",
            "telephone_number": "201-791-2600",
            "fax_number": "201-791-1941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5912 BRECKENRIDGE PKWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336104200",
            "telephone_number": "904-562-1401",
            "fax_number": "904-672-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA CLINICAL LABORATORY, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BIO-REFERENCE LABORATORIES, INC",
        "enumeration_date": "2014-05-22",
        "last_updated": "2018-04-11",
        "status": "A",
        "authorized_official_last_name": "ERDMANN",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "COO; EXECUTIVE VP",
        "authorized_official_telephone_number": "201-791-2600",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800025918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2018; 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.