Provider Demographics
NPI:1811363906
Name:CLINICAL LABORATORY DIAGNOSTICS, LLC.
Entity type:Organization
Organization Name:CLINICAL LABORATORY DIAGNOSTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:HOOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-248-8055
Mailing Address - Street 1:3855 EAST SILVER SPRINGS BLVD.
Mailing Address - Street 2:EXECUTIVE SUITE 105
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470
Mailing Address - Country:US
Mailing Address - Phone:352-622-2566
Mailing Address - Fax:
Practice Address - Street 1:3855 EAST SILVER SPRINGS BLVD.
Practice Address - Street 2:EXECUTIVE SUITE 105
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470
Practice Address - Country:US
Practice Address - Phone:352-622-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257705400Medicaid
FL38333Medicare PIN
FL257705400Medicaid