Provider Demographics
NPI:1962536870
Name:SIGNET DIAGNOSTIC CORPORATION
Entity type:Organization
Organization Name:SIGNET DIAGNOSTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-848-7111
Mailing Address - Street 1:3555 FISCAL CT
Mailing Address - Street 2:SUITE #9
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-1757
Mailing Address - Country:US
Mailing Address - Phone:561-848-7111
Mailing Address - Fax:561-848-6655
Practice Address - Street 1:3555 FISCAL CT
Practice Address - Street 2:SUITE #9
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-1757
Practice Address - Country:US
Practice Address - Phone:561-848-7111
Practice Address - Fax:561-848-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL9046OtherBCBS