Basic Information
| Provider Information | |||||||||
| NPI: | 1083609127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RMG ART LABORATORY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5245 E FLETCHER AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336171126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139147304 | ||||||||
| FaxNumber: | 8139147314 | ||||||||
| Practice Location | |||||||||
| Address1: | 5245 E FLETCHER AVE | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336171126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139147304 | ||||||||
| FaxNumber: | 8139147314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 03/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | BERNHISEL | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8139147304 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 800020271 | FL | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 10D1035477 | 01 | FL | CLIA | OTHER | L9269 | 01 | FL | BCBS NUMBER | OTHER |