MEDICARE: ALLIANCE STAT LABS LLC

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

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	:	1417618315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE STAT LABS LLC

Provider Business Mailing Address
First Line	:	5303 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-3230
Country	:	US
Telephone Number	:	800-471-0846
Fax Number	:	512-532-0923

Provider Business Practice Location Address
First Line	:	5303 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-3230
Country	:	US
Telephone Number	:	800-471-0846
Fax Number	:	512-532-0923

Authorized Official
Title or Position	:	BILLER
Name	:	TYLER PENROD
Credential	:
Telephone Number	:	305-900-4715

Provider Enumeration Date	:	01/04/2022
Last Update Date	:	01/04/2022

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Directions to “ALLIANCE STAT LABS LLC ” Practice Location

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