1235327032 NPI number — DOLPHIN DIAGNOSTICS LLC

Table of content: (NPI 1235327032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235327032 NPI number — DOLPHIN DIAGNOSTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOLPHIN DIAGNOSTICS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235327032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10101 DR MARTIN LUTHER KING ST N STE 285
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33716-3823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-797-8461
Provider Business Mailing Address Fax Number:
727-797-8467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10101 DR MARTIN LUTHER KING ST N
Provider Second Line Business Practice Location Address:
SUITE 285
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33716-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-797-8461
Provider Business Practice Location Address Fax Number:
727-797-8467
Provider Enumeration Date:
10/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOLLINGER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
DIRECTOR OF REGULATORY COMPLIANCE
Authorized Official Telephone Number:
727-797-8461

Provider Taxonomy Codes

  • Taxonomy code: 246Z00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E4709A . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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