Florida Lab Source

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

800027325 Issued in FL

Legal business name

FLORIDA LAB SOURCE

Practice address

11350 SW Village Pkwy
Port St Lucie, FL 34987-2352

Phone

(561) 309-0134

NPI assigned

Nov 30, 2015

Organization subpart

No

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

Authorized official

Name

Mike Anthony Cirillo

Title

President

Phone

(561) 309-0134

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448841600000",
    "number": "1912371089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13805 FOLKSTONE CIR",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334147704",
            "telephone_number": "561-309-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11350 SW VILLAGE PKWY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872352",
            "telephone_number": "561-309-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA LAB SOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-30",
        "last_updated": "2015-11-30",
        "status": "A",
        "authorized_official_last_name": "CIRILLO",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-309-0134"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800027325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Florida Department of Health
• Florida Department of Veterans Affairs
• Florida Em-I Medical Services PA
• Florida Family Dental LLC
• Florida Health Plus System Inc
• Florida Medical Center
• Florida Orthopedics and Neurosurgery LLC
• Florida Pain & Rehabilitation Institute Inc
• Florida Psychiatry Associates LLC
• Florida Spine and Disc Center, Inc.

• Clinical Medical Laboratory in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2015; 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.