Provider Demographics
NPI:1316074594
Name:MEDICAL DIAGNOSTIC SERVICES OF CENTRAL FLORIDA INC
Entity type:Organization
Organization Name:MEDICAL DIAGNOSTIC SERVICES OF CENTRAL FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:OSULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:ROCS
Authorized Official - Phone:352-489-5873
Mailing Address - Street 1:5515 W OAKHILL ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34438-2534
Mailing Address - Country:US
Mailing Address - Phone:352-489-5873
Mailing Address - Fax:352-489-5873
Practice Address - Street 1:1150 HWY 41
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-1150
Practice Address - Country:US
Practice Address - Phone:386-792-2662
Practice Address - Fax:386-792-2662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2017OtherBCBS
FL225296OtherAV MED
FLE1291Medicare ID - Type Unspecified