MEDICARE: ALLEGIANCE MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023342391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGIANCE MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	2331 HAMPTON AVE
Second Line	:	LOWER LEVEL
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2908
Country	:	US
Telephone Number	:	314-646-8234
Fax Number	:	314-646-8349

Provider Business Practice Location Address
First Line	:	2331 HAMPTON AVE
Second Line	:	LOWER LEVEL
City	:	SAINT LOUIS
State	:	MO
Zip	:	63139-2908
Country	:	US
Telephone Number	:	314-646-8234
Fax Number	:	314-646-8349

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. TONY BRUCE CAMILLO
Credential	:
Telephone Number	:	314-646-8234

Provider Enumeration Date	:	09/19/2009
Last Update Date	:	05/18/2012

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Directions to “ALLEGIANCE MEDICAL SERVICES ” Practice Location

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