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NPI Code Detail

MEDICARE: SOUTHEAST MEDICAL LAB INC

MEDICARE: SOUTHEAST MEDICAL LAB INC
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
1291U00000XClinical Medical Laboratory800016264FL

General Provider Information

NPI Number : 1417909433
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST MEDICAL LAB INC
Provider Business Mailing Address
First Line : 6920 NW 72ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33166-3036
Country : US
Telephone Number : 305-805-3748
Fax Number : 305-805-3749
Provider Business Practice Location Address
First Line : 6920 NW 72ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33166-3036
Country : US
Telephone Number : 305-805-3748
Fax Number : 305-805-3749
Authorized Official
Title or Position : PRESIDENT
Name : MR. MANUEL HERNANDEZ
Credential : LABORATORY SUPERVISO
Telephone Number : 305-805-3748
Provider Enumeration Date : 05/17/2006
Last Update Date : 11/26/2012

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Directions to “SOUTHEAST MEDICAL LAB INC ” Practice Location

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