Provider Demographics
NPI:1174090724
Name:APPLIED INGENUITY DIAGNOSTICS LLC
Entity type:Organization
Organization Name:APPLIED INGENUITY DIAGNOSTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOSALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-277-5439
Mailing Address - Street 1:2531 NW 41ST ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7490
Mailing Address - Country:US
Mailing Address - Phone:877-277-5439
Mailing Address - Fax:877-277-5439
Practice Address - Street 1:7040 LAKE ELLENOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5750
Practice Address - Country:US
Practice Address - Phone:877-277-5439
Practice Address - Fax:877-577-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102755900Medicaid