Basic Information
| Provider Information | |||||||||
| NPI: | 1417960626 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BERNHARDT LABORATORIES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11025 RCA CENTER DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334104269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615145822 | ||||||||
| FaxNumber: | 8447519262 | ||||||||
| Practice Location | |||||||||
| Address1: | 3728 PHILIPS HWY STE 64 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322076898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042962333 | ||||||||
| FaxNumber: | 9042968467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | VALLADARES | ||||||||
| AuthorizedOfficialFirstName: | DINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, CREDENTIALING & PE | ||||||||
| AuthorizedOfficialTelephone: | 5615145822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 800001509 | FL | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 002263700 | 05 | FL | MEDICAID |