Provider Demographics
NPI:1144001074
Name:FLORIDA MEDICAL LAB
Entity type:Organization
Organization Name:FLORIDA MEDICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:IDLIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:980-721-6622
Mailing Address - Street 1:631 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:631 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3922
Practice Address - Country:US
Practice Address - Phone:980-721-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA MEDICAL LAB GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory