Ancient City Diagnostics, LLC

Primary specialty

Military Clinical Medical LaboratoryTaxonomy code 291900000X

Legal business name

ANCIENT CITY DIAGNOSTICS, LLC

Practice address

150 Southpark Blvd Ste 206
Saint Augustine, FL 32086-5179

Phone

(904) 439-3414

NPI assigned

Mar 17, 2020

Last updated

Mar 17, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Christopher Edmondson

Title

Owner

Phone

(904) 439-3414

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1584403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584403200000",
    "number": "1629604046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8563 ARGYLE BUSINESS LOOP STE 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322446613",
            "telephone_number": "904-439-3414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SOUTHPARK BLVD STE 206",
            "city": "SAINT AUGUSTINE",
            "state": "FL",
            "postal_code": "320865179",
            "telephone_number": "904-439-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANCIENT CITY DIAGNOSTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-17",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-439-3414"
    },
    "taxonomies": [
        {
            "code": "291900000X",
            "taxonomy_group": "",
            "desc": "Military Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Megan E Andersen, APRN

• Military Clinical Medical Laboratory in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Military Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; 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.