MEDICARE: AMERICAN LABORATORIES GROUP, 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	45D2100510	TX

General Provider Information

NPI Number	:	1851746960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN LABORATORIES GROUP, LLC

Provider Business Mailing Address
First Line	:	5710 LBJ FREEWAY
Second Line	:	SUITE 203
City	:	DALLAS
State	:	TX
Zip	:	75240-6568
Country	:	US
Telephone Number	:	214-888-8099
Fax Number	:	214-261-2217

Provider Business Practice Location Address
First Line	:	5710 LBJ FREEWAY
Second Line	:	SUITE 203
City	:	DALLAS
State	:	TX
Zip	:	75240-6568
Country	:	US
Telephone Number	:	214-888-8099
Fax Number	:	214-261-2217

Authorized Official
Title or Position	:	CREDENTIALING CONTACT
Name	:	MR. NIZAR A ALIKHAN
Credential	:
Telephone Number	:	214-888-8099

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	04/26/2016

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