Provider Demographics
NPI:1487954913
Name:AMERICAN DIAGNOSTICS SERVICES LLC
Entity type:Organization
Organization Name:AMERICAN DIAGNOSTICS SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-786-8015
Mailing Address - Street 1:930 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9481
Mailing Address - Country:US
Mailing Address - Phone:904-406-0310
Mailing Address - Fax:410-472-1754
Practice Address - Street 1:930 RIDGEBROOK RD FL 3
Practice Address - Street 2:
Practice Address - City:SPARKS GLENCOE
Practice Address - State:MD
Practice Address - Zip Code:21152-9481
Practice Address - Country:US
Practice Address - Phone:800-786-8015
Practice Address - Fax:410-472-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1487954913Medicaid
NE10026119900Medicaid
MN1487954913Medicaid
NEP00972855OtherRR MEDICARE
MNP01101435OtherRR MEDICARE
NY03340952Medicaid
WV3910006905Medicaid
OKP01101462OtherRR MEDICARE
IAP01101442OtherRR MEDICARE
MSP01101464OtherRR MEDICARE
NYP01107140OtherRR MEDICARE
OK2400109010AMedicaid
MS3106321Medicaid
OKP01101462OtherRR MEDICARE
MN1487954913Medicaid
NYJ300050178Medicare PIN
OK2400109010AMedicaid
MN470000088Medicare PIN
NE10026119900Medicaid
OKOKB6053Medicare PIN
IAIB2231Medicare PIN