Ancient City Diagnostics, LLC
Military Clinical Medical Laboratory in Saint Augustine, FL. Organization (NPI-2).
NPI number1629604046
StatusActive
Last updated in NPPESMar 17, 2020
Details
- NPI
- 1629604046
- Entity type
- Organization (NPI-2)
- Legal business name
- Ancient City Diagnostics, LLC
- Organization subpart
- No
- Enumeration date
- Mar 17, 2020
- Certification date
- Mar 17, 2020
- Last updated
- Mar 17, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 291900000X | Military Clinical Medical Laboratory | – | – | Yes |
Practice location
150 Southpark Blvd Ste 206Saint Augustine, FL 32086-5179
Phone 904-439-3414
Mailing address
8563 Argyle Business Loop Ste 5Jacksonville, FL 32244-6613
Phone 904-439-3414
Authorized official
Christopher Edmondson
Owner
9044393414
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